Habib Nouri

Calcitonin use in giant cell bone tumors

INTRODUCTION As osteoclast, giant cell tumors express calcitonin receptors. The aim of this paper is to assess treatment using salmon calcitonin after curettage. MATERIAL AND METHODS We retrospectively reviewed 25 patients with giant cell tumor of the appendicular skeleton treated with a single protocol of calcitonin administration following curettage in order to assess the effectiveness of calcitonin in reducing the rate of local recurrence. RESULTS The mean duration follow-up was 68 months. Thirteen patients (52%) had local recurrence. Eight of them were treated successfully after repeated curettage and calcitonin. Four patients had bone resection and one patient had curettage and cement filling. All patients with cavity left empty had ossified and the functional score as assessed by the MSTS score was 28.02/30. CONCLUSION This study suggests that the use of calcitonin as adjuvant is not effective and that filling agents are not required after curettage of giant cell tumors. LEVEL OF EVIDENCE Level 4.

The accessory soleus muscle: a report of two cases with review of the literature

IntroductionThe purpose of this study is to present two cases of accessory soleus muscle diagnosed in young athletes. The authors give diagnostic and therapeutic recommendations with a literature review.Case reportsTwo young athletes consulted us for leg pain increasing with athletic activity. Physical examination revealed a soft, non-tender mass medial to Achilles’ tendon. Lateral X-ray view of both ankles revealed an obliteration of Kager’s fat pad. Computed tomography (CT) and magnetic resonance imaging (MRI) showed muscular masses of the posterior compartment of the leg. The accessory soleus was excised from its origin to its distal insertion. The postoperative outcome was good and the previous sporty activity was regained within few months.DiscussionThe accessory soleus muscle is a rare supernumerary muscle of the leg whose clinical manifestation is exceptional. Different anatomic types have been described. Clinical presentation consists most often in a mass of the postero-medial compartment of the leg, which becomes painful during the effort. MRI is the major diagnostic tool. It not only allows diagnostic confirmation but also guides the treatment. As far as therapy is concerned, surgery is not the only alternative, but it remains the most efficient one. Conclusion: The accessory soleus is not so rare. Recognizing this anomaly using clinical findings, X-rays and MRI investigation results in proposing a management adapted to the importance of the functional discomfort. Surgery remains the most efficient treatment.RésuméIntroductionLe muscle soléaire accessoire est une variété anatomique rare, consistant en un muscle surnuméraire bien individualisé. à travers deux observations et une revue de la littérature, les auteurs proposent une démarche diagnostique et thérapeutique.ObservationsNous rapportons les cas de deux jeunes sportifs (un homme et une femme) qui consultaient pour des douleurs de la jambe augmentant à l’effort, avec une tuméfaction palpable du mollet. Les radiographies standard montraient un comblement du triangle de Kager. L’échographie et l’IRM ont objectivé un muscle soléaire surnuméraire s’insérant distalement sur la face interne du calcanéum. Le traitement a consisté en une exérèse chirurgicale du muscle surnuméraire symptomatique. L’évolution a été favorable avec la reprise du sport après quelques mois.DiscussionLe muscle soléaire accessoire est un muscle surnuméraire de la loge postérieure de la jambe. Son insertion proximale se fait sur la face postérieure du tibia ou sur la face antérieure de l’aponévrose du muscle soléaire. Le premier symptôme évocateur est une douleur de la partie postérointerne du mollet apparaissant à l’effort, accompagnée d’une tuméfaction sus- et rétromalléolaire médiale. L’échographie permet de visualiser une masse d’échostructure identique à celle des muscles adjacents. L’IRM est actuellement l’examen de certitude, elle permet d’identifier les insertions proximales et distales du muscle accessoire. Le traitement dépend de l’importance de la gêne fonctionnelle. Souvent une exérèse chirurgicale complète est nécessaire.ConclusionLa fréquence du muscle soléaire accessoire n’est pas négligeable; cependant, son incidence clinique est beaucoup plus rare, elle est faite souvent de syndrome de loge chronique de la jambe. Le diagnostic repose essentiellement sur l’IRM. Le traitement est essentiellement chirurgical.

Tumour-like lesions of the infrapatellar fat pad

Three different tumour-like lesions within the infrapatellar fat pad, an osteochondroma, a localised pigmented villonodular synovitis and a synovial cyst are reported. The osteochondroma and the pigmented villonodular synovitis were treated by marginal excision, and the synovial cyst was resected using arthroscopy.

Adamantinome dédifférencié associé à une dysplasie fibreuse

Summary A 21-year-old patient presented with an aggressive lesion of the left tibia associated to lymph nodes and lung metastasis. Histological examination revealed a high-grade spindle cell sarcoma involving some areas of cytokeratine positive cells. Ultrastructural examination showed the presence of epithelial features in the sarcomatoid cells. The diagnosis of dedifferentiated spindle-celled adamantinoma was established. A second lesion of the right tibia was diagnosed as fibrous dysplasia. The patient had a leg amputation. He died 2 years later with multiple lung and bone metastases. The diagnosis of dedifferentiated adamantinoma should be considered when a clinician is confronted with a tibial biopsy of a “keratin-positive sarcoma”. The association with fibrous dysplasia in this case is discussed.

L’arthrodèse du genou après résection tumorale maligne par fibula vascularisée retournée

INTRODUCTION Knee arthrodesis is one of the reconstruction options for limb preservation after malignant tumor resection. Vascularised rotatory fibular transfer allows biological and, thus,definitive reconstruction. The goal of this work was to analyse the results of knee arthrodesis with vascularised fibular graft after tumor resection and to discuss the reliability of this technique. PATIENTS AND METHODS We report a retrospective series of 13 patients with an average age of 29.6 years. The pathological diagnosis was bone sarcoma in 12 cases and synovial chondrosarcoma in one case. Resection/arthrodesis was undertaken as the primary procedure in 11 cases.In two cases, arthrodesis was indicated after failure of an endoprosthesis. Reconstruction was achieved with a vascularised fibular rotatory transfer in all cases. For stabilisation, an external fixator was utilised in eight cases, a femorotibial nail in three cases, and a plate in two cases.Mean follow-up was 6 years. RESULTS We encountered infection in 53% of cases, mechanical complications in 53% of cases,and nerve palsy in 23% of cases. Four patients died from metastases (only one had arthrodesis complete union). In the nine surviving patients, arthrodesis was fully united in seven cases,after an average period of 36 months. The functional score average (Enneking classification)was 20 points. DISCUSSION Knee arthrodesis after tumor resection is a complex technique. Septic complications and mechanical failure are frequent regardless of the technique employed. They are related to the extent of bone sacrifice but also to that of soft tissues. The use of vascularised fibula alone and stabilisation by external fixation were the main shortcomings in this series. TYPE OF STUDY RETROSPECTIVE: Level IV.