Orthopedics

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.

Introduction Bilateral asymmetric traumatic hip dislocation is a rare orthopaedic condition. Only few cases are reported in the literature. Most of the bilateral hip dislocations are posterior dislocation. In few numbers it is a combination of both anterior and posterior dislocation. We report such a case of asymmetric traumatic bilateral hip dislocation in an adult of 30 years of age. Case Report A 30 year adult male was presented to our casualty following road traffic accident with complaints of severe pain in the hips with deformity and inability to move. The right hip was abducted and externally rotated and the left hip was adducted, flexed and internally rotated. Clinically the right hip was dislocated anteriorly while the left hip was dislocated posteriorly. The clinical findings were confirmed by X-ray of the pelvis with hips. Reduced under general anaesthesia within four hours, both the hip showed concentric reduction. Conclusion Bilateral asymmetric dislocation of the hip, though a rare condition may present because of increase in number of road traffic accidents. Early diagnosis and reduction of the dislocated joint is the key to regain a normal hip joint and to prevent avascular necrosis of the femoral head. Key Words: Hip dislocation; asymmetric; bilateral; adult; avascular necrosis

An uncommon case has been reported of bilateral transscaphoid-perilunate dislocation racture following trauma. A 21-year-old male with bilateral transscapholunate dislocation was treated by open reduction and internal fixation. The case was examined in detail, and compared to the findings in the literature; observations regarding fracture prognosis were also made. Two years post-surgery, the patient remained asymptomatic.

Avulsion fractures of the tibial tuberosity are uncommon. There occur in well-developed, muscular athletic male individuals nearing skeletal maturity. The authors present a case of an 15-year-old boy who has a type IIB avulsion-fracture of the tibial tubercle. Surgical treatment gives an excellent outcome. We compare it with the literature.

The authors report a case of mycetoma of the foot (Madura foot). This is a patient of 34 yearswith a chronicswelling of the right foot withfistulasgiving a purulent yellow ishcontaining grains. Antibiotics and antifungaltreatments have not worked. Radical treatmentwasnecessary.

Traumatic shoulder dislocation in Child is a very rare injury. The treatment and the recurrence rate are differents then adult. We report a case of shoulder dislocation in a 9 years old judoka.