Orthopedics

The high-energy trauma has become frequent cause of traffic accidents. We oftensee multiple lesions, fractures, dislocations, soft tissue damage in the same patient on the same members or different members .We report the case of a rare combination of lesion streated in our department.

Patellar tendon rupture is a rare disease. It is often confused with lesions of the quadriceps tendon, fins and patellar fractures parcel of the patella. We report ten cases of rupture of the patellar tendon which eight were new and two neglected. Treatment was always surgical. In recent lesions (8 cases) by a simple suture nonabsorbable suture was performed, it was reinforced by a steel strapping over. Plasty further by the semitendinosus tendon was necessary in one case. In both cases neglected plasty was necessary. It was conducted by the aponeurosis of the quadriceps in one case, the tendon of the semitendinosus in the other cases. The results are satisfactory. They are good in eight cases of recent lesion and two lesions in ways neglected. Early diagnosis is easy. It allows access to the best results in the treatment of fresh lesions. The treatment of neglected injuries, despite the various techniques, gives results fair or poor.

Dislocation of the tibiotalar joint without fracture or diastasis isa rare injury. We report a case of a close poster medialankle dislocation, without fracture in a 18 old soccer player, with good resultsafter an orthopedic treatment.

Distal tibia fractures are complex injuries with a high complication rate. In this retrospective, study, we attempted to detail complications and outcomes of this type of injury in order to determine predictive factors of poor results. Between 2015 and 2017 10patients were admitted for distal tibia fractures. Internal fixation, external fixation, limited internal fixation (K-wires or screws), intramedullary nailing and conservative treatment were the different mode of treatment..The complications occurred in 3 patients. Predictive factors of poor results were fracture severity, complications, malunion severe skin and soft tissue injury. We believe that external fixation must be reserved for trauma with severe skin and soft tissue injury, as a temporary solution in a one/two-staged protocol. For other cases, we recommend ORIF with early mobilization.

Simultaneous rupture of the two patellartendons are exceptional in sports young people without predisposing systemic disease. Diagnosis is essentially clinical help with radiography. Surgical treatment gives good result. We report a case of a 35 years old young sport with a subcutaneousbilateral rupture of the patellar tendon.

Bilateral dislocation of the shoulders (anterior or posterior) is a known event after epileptic seizure or electrocution. However this pathology is rare when one side is anterior and the other is posterior. We describe a case of bilateral fracture dislocation of the shoulders after electrocution in a 45 year old woman. Asymmetrical presentation of lesion is exceptional, caused by opposing mechanisms. The diagnosis was made in emergency, and the patient underwent surgical treatment. We review these fracture dislocation types, and we also examine their mechanisms.

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.