Traumatic peroneal split lesion with retinaculum avulsion:Diagnosis and post-operative multymodality imaging

Tears of peroneus brevis tendon represent a cause of underdiagnosed lateral ankle pain and instability. The typical clinical presentation is retro-malleolar pain, in some cases associated with palpable swelling around the fibular malleolus, pain during activities and difficulty in walking. We present a case of peroneus brevis split lesion with superior peroneal retinaculum avulsion in a young athlete who referred to the emergency ward of our hospital for left ankle pain after an inversion injury. An early diagnosis allowed treating the injury and promptly resuming sport activity, after rehabilitation training. Surgical reconstruction key-points and postsurgical follow-up were also discussed. A late diagnosis would have caused a symptomatology worsening and an increased recovery time.

Osteoid Osteoma of the Second Metatarsal: An Exceptional Localization and Unusual Clinical Features

Osteoid osteoma of the foot can be difficult to diagnose, the clinical presentation may be mimicking other local pathologies leading to a considerable delay in diagnosis. We report an exceptional localization of osteoid osteoma in the second metatarsal in a 30-year-old patient, expressed for 3 years by metatarsalgia, with no clinical and radiological architecture defect of the foot. After discovering the nidus, the patient underwent surgical excision with an excellent outcome.

Early Treatment Outcome of Humeral Shaft Fracture Non-Union in Adults: Comparative Study of Plating versus Interlocking Nailing

Background: Fractures of humeral shaft in adults are common injuries. Humeral shafts non-union either from late presentation after initial treatment by traditional bone setters or failed non-operative orthodox care is a major problem in this part of the world. This non-union is a major treatment challenge with increased cost of care and morbidity in this part of the world. Humeral shaft non-union can be treated with locked intra-medullary nailing (LIMN) or dynamic compression plating (DCP). Study on comparison of these methods of fixation in this part of the world is scarce in literature search, hence the reason for this study. Objective: The objectives of this study are: (1) to compare early clinical outcome following fixation of humeral shaft fracture nonunion with DCP versus LIMN;(2) to compare the time of radiologic fracture union of DCP with LIMN;(3) to compare complications following fixation of humeral shaft fracture nonunion with DCP versus LIMN. Patients and Methods: This was a randomized control study done for 2 years in which fifty adult patients with humeral shaft non-union were recruited. The patients were grouped into 2 (P = DCP & N = LIMN). Forty five of the patients completed the follow up periods of the study and then analyzed. The P group had ORIF with DCP while the N group had ORIF with LIMN. Both groups had grafting with cancellous bones. Each patient was followed up for a period of 6 months at the time which radiographic union is expected. Any patient without clinical and/or radiographic evidence of union after six months of surgery was diagnosed as having recurrent non-union. The data generated was analyzed using SPSS Version 23. The results were presented in charts and tables. The paired t-test was used while considering p value Result: Forty five patients completed follow up. There was a male preponderance (4:1), right humerus predominated (3:2). Motor vehicular accidents were the commonest cause of the fractures (62%). Most non-union fractures occurred at the level of the middle 3rd of the humeral shaft (60%). Failed TBS treatment was the commonest indication for the osteosynthesis (71%). More patients had plating (53%) compared to 47% who had LIMN. Most patients (93.4%) had union between 3 to 6 months irrespective of fixation type with no significant statistical difference between the union rate of DCP and LIMN (p value 0.06) with similar functional outcome and complication rates irrespective of the type of fixation. Conclusion: This study showed that the success rates in term of fracture union, outcome functional grades and complication rates were not directly dependent on the types of the fixation: plating or locked intra-medullary nailing.

Pediatric flexible flatfoot: Does obesity influence the outcomes of arthroereisis?

BACKGROUND Childhood obesity has emerged in the last decades as an important public health problem worldwide.Although relationships between obesity and flatfoot have been shown,no studies have investigated the influence of obesity on arthroereisis outcomes.AIM To evaluate correlations between childhood overweight/obesity and clinical and radiographic outcomes after subtalar arthroereisis with self-locking implants.METHODS This retrospective study included one hundred and sixty-nine pediatric patients(10-14 years old)who underwent subtalar arthroereisis(PEEK PitStop®device)for severe flexible flatfoot.Exclusion criteria were additional procedures,revision of previous corrective surgeries,rigid flatfoot with severe deformity,and neurologi-cal or post-traumatic flatfoot.Preoperative/postoperative European Foot and Ankle Society(EFAS)and visual analogue scale(VAS)scores were determined;radiographic assessment was conducted on weight-bearing foot X-rays:Kite angle,first metatarsal-talus angle,Meary angle,calcaneal pitch angle and lateral talo-calcaneal angle were analyzed.RESULTS EFAS and VAS scores improved post-operatively in the whole population.Only seven cases with complications were reported.Radiographic assessment revealed an improvement in all angles.Statistical analysis demonstrated that the impact of obesity was significant on arthroereisis outcomes:Relationships were reported between BMI and postoperative EFAS/VAS scores,postoperative calcaneal pitch angle,Kite angle,Meary angle and talo-first meta-tarsal angle.CONCLUSION Although arthroereisis represents a very effective and valid treatment for flatfoot both in normal weight and obese children,obesity significantly influences clinical and radiographic outcomes of arthroereisis,and obese children tend to perceive more pain and discomfort.

Solitary Osteogenic Exostosis of the Femur Revealed by Recurring Acute Distal Thigh Pain: About a Case

Introduction: Solitary exostoses are the most common benign tumors of the fertile metaphyses of the long bones of children. Their radiological diagnosis of metaphyseal bone growth must be confirmed on pathological examination. These tumors can remain asymptomatic for a long time and reveal themselves during a particularly vascular complication. The objective of this study was to describe the epidemiological, diagnostic, therapeutic and evolutionary aspects of these tumors. Patient and Observation: We report the case of a 15-year-old adolescent girl, with no particular pathological history, received in the pediatric surgery department of the Donka National Hospital (HND) of the Conakry University Hospital for recurrent acute painful swelling of the lower third of the left thigh in an afebrile context accompanied by lameness and stopping school for a few days (2 - 3 days). The symptoms appear to have evolved over the past 3 years and after physical activities. It regresses with rest, analgesics and non-steroidal anti-inflammatory drugs. The notion of trauma and sickle cell disease was not reported in the patient's clinical history. It is the persistence of the symptomatology which motivates the said consultation. On palpation, a small hard mass is noted at the expense of the internal metaphysis of the left distal femur. Deep palpation of this area causes a tingling sensation and during rapid mobilization of the knee. The remainder of the orthopedic examination was unremarkable. Standard x-ray of the femur shows a bony growth with a pointed tip from the distal metaphysis of the left femur. On surgical exploration, we noted a wedge-shaped exostosis oriented towards the vastus medialis muscle. Histological examination of the surgical specimen confirms osteogenic exostosis. There is no recurrence after 2 years. Conclusion: The distal femoral metaphysis is the most common location of solitary osteochondromas in children. Their definitive diagnosis requires the histology of the surgical specimen. Only symptomatic exostoses should be operated on in children.

Vitamin D Deficiency and Pseudofractures in Child-Bearing Egyptian Women: Successful Medical Treatment Helps to Avoid Fractures and Surgical Interference

Background: Recent evidence for the effects of vitamin D and recognition of the high prevalence of its deficiency has increased the interest in it. Vitamin D-sub nutrition may contribute to the risk of a wide range of disorders. Methods: The females in the child-bearing period attending the endocrinology and orthopedic out-patient clinics complaining of pain and/or tenderness at the groin were evaluated. Patients with chronic metabolic or skeletal illness, primary hyperparathyroidism, and patients receiving drugs that interfere with bone mineral metabolisms were excluded. One hundred accepted and consented to participation in the study. All the participants were subjected to full history taking, clinical evaluation, laboratory investigations including serum Ca, Ph, PTH, ALP, TSH, F T4, F T3, Cortisol level, and 25(OH)D level. Plain X-ray was done for the regions of bony tenderness. The subjects were divided into 2 groups based on the presence or absence of pseudo-fractures (looser zones). They were treated and followed up till normalization of the laboratory parameters and healing of the looser zones. Results: The mean age for patients was 30.45 ± 5.8, their mean 25(OH) vitamin D level was 14.7 ± 5.9 ng/ml, the mean PTH was 195.7 ± 162.6, and looser zones were evident in the X-rays of 34 patients. The serum 25(OH)D showed significant negative correlations with veiling, parity, localized hip pain, and tenderness, ALP, PTH, but, a significant positive correlation with sun exposure, dairy products consumption, vitamin D supplementation, and serum calcium levels. The independent factors associated with hypovitaminosis D were the lack of sun exposure, lack of vitamin D supplementation, and the presence of pseudo- fracture (p ≤ 0.009, 0.038, and 0.001 respectively). No surgery was required in any of our patients. Conclusions: Vitamin D deficiency is common in our region. The main risk factors are decreased sun exposure, low dairy products consumption, and lack of vitamin D supplementation. Successful medical treatment may be helpful to satisfy the patient, avoid true fracture and further major surgical treatments.

Threatened Aortic Injury by Thoracic Pedicle Screw: A Case Report

Iatrogenic vascular injury during posterior spinal surgery is a rare but potentially serious complication with treatment challenges. We report the case of threatened aortic injury by pedicle screw impingement during posterior fixation of thoracic spine T7 - T8 fracture dislocation. The removal of the conflicting screws was done posteriorly after a visual control of the absence of adventitious break-in by a thoracotomy.

Olecranon Fractures in Children: About 21 Cases Treated at the Owendo University Hospital Center at Libreville (Gabon)

Background: The olecranon fractures in children are relatively rare articular fractures. The aim of this work is to study the epidemiological, clinical and therapeutic particularities of this fracture in children at Owendo University Teaching Hospital. Patients and Methods: This was a retrospective analytical, monocentric study over 2 years from January 1, 2018 to January 1, 2020 at the Owendo University Hospital in Libreville and relating to the medical files of patients treated for a fracture of the olecranon in children in the service and regularly followed in outpatient consultation. Results: We collected 21 patients with an average age of 8.7 years. Falls dominated the etiologies. The Bracq classification was the one used in our series with the predominance of type D. The treatment was orthopedic in 33.3% of cases and surgical in 66.7% of cases. With an average follow-up of 12 months, the results were good in 71.5%, average in 19.0% and poor in 9.5%. Conclusion: The analysis of our results compared to those of the authors of the literature according to the precise parameters seems satisfactory.

Postoperative subacute static progressive stretch does not increase the risk of distal lower limb venous thromboembolism

Purpose:Static progressive stretch(SPS)can be applied to treat chronic joint stiffness.However,the impacts of subacute application of SPS to the distal lower limbs,where deep vein thrombosis(DVT)is common,on venous thromboembolism remain unclear.This study aims to explore the risk of venous thromboembolism events following subacute application of SPS.Methods:A retrospective cohort study was conducted on patients diagnosed with DVT following a lower extremity orthopedic surgery before being transferred to the rehabilitation ward from May 2017 to May 2022.Patients with unilateral lower limb comminuted para-articular fractures,transferred to rehabilitation ward for further treatment within 3 weeks after operation,followed up more than 12 weeks since initial manual physiotherapy,and diagnosed DVT by ultrasound before rehabilitation course were included in the study.Patients with polytrauma,without evidence of previous peripheral vascular disease or incompetence,had medication for thrombosis treatment or prophylaxis before the operation,detected with paralysis due to nervous system impairment,infected after operation during the regime,or with acute progression of DVT were excluded.The included patients were randomized to the standard physiotherapy and the SPS integrated groups for observation.Associated DVT and pulmonary embolism data were collected during the physiotherapy course to compare the groups.SSPS 28.0 and GraphPad Prism 9 were used for data processing.Ap<0.05 was set significant difference.Results:In total of 154 patients with DVT participating in this study,75 of them were treated with additional SPS for postoperative rehabilitation.The participants in the SPS group showed improved range of motion(12.3°±6.7°).However,in the SPS group,there was no difference in thrombosis volume between the start and termination(p=0.106,p=0.787,respectively),although difference was seen intra-therapy(p<0.001).Contingency analysis revealed the pulmonary embolism incidence(OR=0.703)in the SPS group compared to the mean physiotherapy.Conclusion:The SPS technique is a safe and reliable option to prevent potential joint stiffness without aggravating the risk of distal DVT for postoperative patients suffering from relevant trauma.

Place of the reposition flap in the treatment of distal amputations of the fingers

Purpose： Distal finger amputations pose a therapeutic problem with the distal fragment quality. Reimplantation remains the reference treatment for functional and aesthetic recovery of the hand. The interest of this study is to propose the reposition flap as an alternative to different hedging techniques in the proximal stump, in many situations where revascularization is impossible. It consists in osteosynthesis of the bone fragment and its coverage by a pedicled local flap. Methods： The technique of reposition flap was evaluated retrospectively between 2003 and 2016 through a study of 13 patients compiled in Nabeul orthopedic department. For each patient, the sensitivity, the pulp trophicity, the interphalangeal mobility, the digital length, the appearance of the nail and radiological consolidation were evaluated. Results： The reposition flap keeps more than 80% of the length of p3. This procedure improves nail aesthetics in comparison with the regularizations. There is no significant difference in sensitivity of the pulp or of the mobility of the distal inter-phalangeal （DIP） joint as a function of the technique studied. However there is a significant difference in average test of the Quick Dash （350 against 500 for regularizations）. Conclusion： The reposition flap seems to be a good alternative to regularization in the context of trans-p3 fingers amputations, in which the distal fragment is not revascularizable. It allows better aesthetic and functional results.

Heel pain： A systematic review

Heel pain is a very common foot disease. Varieties of names such as plantar fasciitis, jogger＇s heel, tennis heal, policeman＇s heel are used to describe it. Mechanical factors are the most common etiology of heel pain. Common causes of hell pain includes： Plantar Fasciitis, Heel Spur, Sever＇s Disease, Heel bump, Achilles Tendinopathy, Heel neuritis, Heel bursitis. The diagnosis is mostly based on clinical examination. Normally, the location of the pain and the absence of associated symptoms indicating a systemic disease strongly suggest the diagnosis. Several therapies exist including rest, physical therapy, stretching, and change in footwear, arch supports, orthotics, night splints, anti-inflammatory agents, and surgery. Almost all patients respond to conservative nonsurgical therapy. Surgery is the last treatment option if all other treatments had failed. Rest, ice, massage, the use of correct exercise and complying with a doctor＇s advice all play important part in helping to recover from this hell pain condition, but getting good quality, suitable shoes with the appropriate amount of support for the whole foot is the most important.