Orthopedics

The rupture of the Achilles tendon, so frequent especially in sports, has an impact which the increase was significant in the world and in our country in recent years, parallel to gain popularity in sports and the absence of means of prevention. In this retrospective study, we propose to evaluate different surgical techniques with the precision of epidemiological, clinical of the injury. This is a study of 49 patients treated between January 2008 and November 2013 in the service of Orthopaedic Traumatology CHU Ibn Sina in Rabat with a frequency of 8.5 cases per year. Our patients are divided into 47 men and 2 women, average age was 34 years with a maximum of cases between 30 and 50 years. Sports injuries were responsible for 51% of lesions with no predominance of the right side from the left side. The diagnosis was evident on clinical examination. All patients underwent conventional open surgery, the technique of Bosworth was slightly dominant. Two patients had a skin infection. No cases of postoperative pain or recurrent rupture occurred. The long-term results were evaluated according to the criteria of Mc Comis with a mean of 2.5 years. Thus, we found 95.9% excellent and good results and 4.08 of mayens results. The Achilles tendon is the largest and strongest tendon in the human body, the impact of his break has long been considered rare; the marked development of sports and leisure activities for the considerably increase. Treatment of ruptured Achilles tendon been no consensus in the light of recent clinical studies, it appears that for active patients and especially sports the treatment of choice is surgical, but the choice between conventional surgical techniques and minimally invasive remains debated. In Morocco, conventional surgical techniques are commonly used while in developed countries the minimally invasive surgery is becoming more and more its place.

Scaphoid fracture, untreated or badly treated, progresses to non-union. The treatment of scaphoid non-union is surgical. This work aims to discuss and analyze different techniques used in the treatment of scaphoid non-unions and their functional outcomes.Our study focuses on fifteen observations collected of scaphoid non-union in the Rabat Ibn Sina Hospital's department of traumatology-orthopaedic, over a period of six years (2007-2012). The analysis focused on the epidemiological, clinical, radiological data, surgical techniques and post-operative evaluation. The average age is 30 years, with a male predominance. One third of patients are manual workers, the dominant hand is affected in 67% of cases. The average trauma - treatment delay is 50.1 months. All patients presented pain and functional impairment with decreased range of motion. The X-ray made in all patients found, according to the classification of Alnot, 40% stage IIA, stage IIB 46.6%, 6.7% stage IIIB and stage IV 6.7% other. Most of our patients (13 out 15 cases) were treated by the Matti Russe operation, the iliac graft was in 11 cases, and radial in 2 cases. Resection of the first carpal row was performed in 2 cases. The evolution was marked by the disappearance of pain in 12 patients and improvements of motion in 10 patients. The Matti Russe operation is an excellent technique for treatment of scaphoid non-union without necrosis or osteoarthritis, this technique gives good functional results. However, only early diagnosis and adequate treatment of scaphoid fracture before non-union can recover normal mobility and avoid aftermaths.

Osteoid osteoma is a benign osseous tumor of unknown origin, which affects preferentially the long bones. The localization in the phalanx is unusual and difficult to diagnose. We present a case of a twenty-year-old student, presenting with a painful swelling of the first phalanx of the right second finger of six months duration, not responding to anti-inflammatory drugs. The lesion was excised, and the histology confirmed the diagnosis of osteoid osteoma. Through our observation and after a review of the literature, we analyze the clinical and paraclinical appearance of this uncommon localization, the differential diagnosis, and finally the therapeutic possibilities.

Mucoid cysts tibiofibular joint top (TFS) is a rare cause of nerve compression at the knee. We report the observation of a soldier of 46 years, who presented with painful swelling sitting at the top of the anterolateral aspect of the left leg third with peroneal neuralgia, lasting for four months. Clinical examination revealed an oval mass, deep, sensitive, poorly demarcated sitting on top of the anterolateral compartment of the right leg third. Ultrasound and magnetic resonance imaging (MRI) of the knee revealed an intramuscular myxoid cyst Depond joint superior tibiofibular. Electromyogram (EMG) was in favor of an invasion of the superficial peroneal nerve. A biopsy excision of the lesion was performed. Pathological examination confirmed the diagnosis of a mucoid cyst. The evolution is marked by the complete disappearance of pain, recovery of normal sensitivity and lack of recurrence after a year of decline.

Sport accidents are very common for children and adolescents. They are among the most frequent traumas that occur in domestic and road accidents. They mainly concern the growth plate and the epiphyseal detachments. Among the avulsion fractures of the apophyses of the pelvis, it is very important to cite those of the anterior inferior iliac spine. Although they are rare, they occur most often for adolescents during sport activities. However, they are quite exceptional for adults. In the case of a 14-year-old adolescent with recent basal trauma happening during a soccer game, there was an inguinal pain and functional impairment of the lower limb. The clinical examination found a pain in the mobilization of the right hip in extension. The standard radiograph of the pelvis showed an avulsion fracture of the anterior inferior iliac spine. The patient was treated orthopedically with a rest and discharged from the traumatized lower limb. It has been noticed the disappearance of the pain in a few weeks later and then resumption of the sport activity for six months. During the observation, all attention of the team was centered on this type of specific fracture of the child and the adolescent athlete both diagnosed and how an early and adapted treatment of growth apophysitis helps prevent its occurrence.

Several surgical methods have been described for the treatment of fresh ruptures of the Achilles tendon. We operated 20 patients for a ruptured Achilles tendon. This study concerns 14 men and 6 women with a mean age of 32 years, all operated by the technique Chigot. We regretted having 12 minor complications advanced favorably. One patient broke a second time his tendon two months after surgery. In 75% of patients, previous sports activity was found. Several studies confirm the low complication rate of this technique particularly recurrent rupture compared to conservative treatment. The technique allows Chigot strengthening the Achilles tendon ruptured without resorting to the fascia of the triceps with a low morbidity.

Osteoblastoma is a rare benign bone tumor, occurring during the second and third decade with a male predominance of spinal preferential seat secondarily the long bones of the limbs, rarely ends Its diagnosis is based on a set of arguments; clinical dominated by doctors located, the imaging objective lyric picture surrounded by sclerotic bone reaction and can invade soft tissues, and especially the pathological examination confirmed the diagnosis highlighting a significant proliferation of osteoblastic cells with the presence of osteoid tissue bathed in a lush and richly vascularised connective tissue. Treatment is exclusively surgical resection is complete and guarantee the prevention of recurrence. We report the case of an osteoblastoma of the ankle in a young adult revealed by localized pain and functional impairment. Standard radiography made was considered completely normal and the persistence of complaints CT was performed but was misleading suggestive of osteochondrosis. This is a pathological examination performed on specimens which helped rectify the diagnosis. The suites in this patient were simple, very satisfactory functional outcome osteoblastoma tumor is easily diagnosed if you think, easy treatment if done right.