Hana Sahli

Osteoarticular tuberculosis dactylitis: Four cases

Tuberculosis dactylitis is exceptional. We report 4 cases of osteoarticular tuberculous dactylitis in 3 women and 1 man. The diagnosis was suspected on chronic and insidious clinical presentation, and confirmed by histology. Patients were treated by anti-tubercular drugs with good functional and radiological outcome in all cases. Clinical and therapeutic issues are discussed by the authors in the context of an endemic country.

The epidemiology of tuberculous dactylitis: A case report and review of literature

The literature on tuberculous dactylitis is poor, and most literature consists of isolated case reports. The aim of this case series is to study the particularities and the epidemiological aspects of tuberculous dactylitis in Tunisian patients. Google and Medline search was done using key words “tuberculous dactylitis” and “spina ventosa.” Only Tunisian reports in adult patients were included. Eleven cases including this mentioned case were included in this review. There was a female predominance, high frequency of trauma before disease installation, rarity of predisposing factors, and less inflammation in blood tests when comparing with other cases in literature.

Involvement of foot in patients with spondyloarthritis: Prevalence and clinical features

BACKGROUND The purpose of this study was to evaluate the foot involvement in a group of patients with spondyloarthritis in regard to symptoms, type and frequency of deformities, location and radiological changes. METHODS We conducted a cross sectional study including 60 patients with spondyloarthritis over a period of six months. Anamnesis, clinical examination, podoscopic examination, biological tests and X-rays of feet were done for each patient. RESULTS Foot involvement was found in 31 patients (52%). It was symptomatic in 35% of cases and inaugural in 42% of cases. The most frequent site was the hindfoot (22 patients/31). Radiological findings were: erosion (17%), reconstruction (33%), erosion and reconstruction (50%). Forefoot involvement was found in 18/31 patients. Forefoot deformities were found in 9 patients. Two patients had sausage toe and feet skin abnormalities were observed in 12 patients. At podoscopic examination, 23 patients had abnormal footprints. Foot involvement was more frequent in peripheral spondyloarthritis (p=0.008). Patients with foot involvement had an advanced age of disease onset (p=0.05), a shorter disease duration (p=0.038) and more comorbidities (p=0.039). Foot involvement was correlated with C Reactive protein (p=0.043). CONCLUSION In our study, foot involvement and foot symptoms were seen frequently in spondyloarthritis and it is associated with late onset of the disease and with higher inflammation in blood tests.

Clinical and Radiographic Features of Knee Osteoarthritis of Elderly Patients

BACKGROUND Knee osteoarthritis is a common pathology, characterized by a prevalence that increases with age. Absence of anatomo-clinical correlation is a complex management, particularly in a geriatric setting where it is not well studied. OBJECTIVE The aim of the present study is to investigate the epidemio-clinical profile, functional impairment and radiographic features of knee osteoarthritis in the old patients versus younger patients (<65 years). METHODS Cross-sectional study includes patients who were monitored for 6 months at a rheumatology department for knee osteoarthritis. Epidemio-clinical, anthropometric and radiographic data were gathered. A comparison was made of these various characteristics between patients of over 65 years of age (group1; n=56) and those under 65 (group2; n=56). RESULTS The mean age of the group 1 patients was 71±5 with a clear feminine predominance. Comorbidity was observed in two thirds of cases. More than half of them were overweight. Gonalgia had been evolving for approximately 8.4±9.2 years and was bilateral in 82.6% of the cases and of mechanical type in 94.6% of the cases. The patients experienced an average pain scale of 65.2mm. Pain had an anterior site in major of cases. An axial deviation of the lower limbs were observed in 60.7% of the cases and a limited mobility of the knees in 48.2% of the cases. The mean value of Lequesne index was 11.02±4.8. The walking distance was not limited in 37.5% of the cases. Radiographically, knee osteoarthritis was bilateral in all cases and stage 4 was observed in 50% of the cases. Comparative study showed that elderly patients had a smaller waist size (p=0.003), a longer course of gonalgia (p<0.0001), a widespread site of pain (p=0.004), and a more frequent limitation of walking distance (p<0.0001) as well as more axial deviation (p<0.0001) and joint mobility limitation (p=0.005). Gonalgia manifesting during rest was more frequent in elderly patients (p=0.001). In addition, impaired functioning (p=0.001) and the stage of radiographic damage (p=0.02) were more advanced in elderly patients. CONCLUSION The present study shows that knee osteoarthritis is more severe in the elderly patients in terms of clinical presentation and functional impairment.

AB0909 Septic pseudarthrosis of the humerus treatment using orthfix external fixation

Background The septic pseudarthrosis of the humerus is a very difficult process that poses a towfold challenge: the infection eradication while trying to get consolidation. Objectives The aim of this study was to analyze the results of the treatment of septic pseudarthritis of the humerus with Orthofix monolateral axial external fixator. Methods This is a retrospective study which included 17 medical records of patients treated for septic pseudarthritis of the humerus debridement and stabilization by Orthofix over a period of 7 years. Results They were 13 women and 4 men with a mean age 44 years. The fracture site was most often at the distal half of the humerus. The initial treatment of the fracture was pinning or intramedullar nailing. Surgical management of pseudoarthrosis was performed 3.5 months after the first surgical procedure. All cases had a bone debridement and stabilization with a monoplane Orthofix axial external side. Fifteen cases had also a bone graft. The mean period of stabilization was 7months. Patients were evaluated clinically and radiologically each month. At the mean of three years of follow-up, we obtain osseous consolidation for all patients in the average of seven months. All patients underwent rehabilitation of the shoulder and elbow after treatment. The functional result were excellent results in 47% of cases, good results in 35,3% of cases and poor results in 17,7%. The Quick DASH score average was 28±5. The average of the elbow motion was 109 ° of flexion with an average of 30 °of deficit in extension. The useful range of motion of the elbow was preserved in 14 patients. There was a shaft angulation under 20 ° in 3 cases and over 20 ° in 3 other cases. We noted in four cases a bone shortening consolidations of 2 cm. We had a case of radial nerve neuraprexie which regressed spontaneously. Conclusions Orthofix is the method of choice for the treatment of septic pseudarthritis of the humerus. Associate eradication of the germ antibiotic and steroid intake spongy it allows the consolidation of the bone. Furthermore, the monolateral axial external fixator is tolerated well and allows movement of the shoulder and elbow throughout the period of treatment. Disclosure of Interest None declared

SAT0493 Tuberculosis of The Hand: Clinical Presentation and Treatment

Background The tuberculosis remains one of the most world wide spread infectious diseases. The ostéoarticular localization is rare, affecting the hand remains exceptional. The incidious presentation, the poor symptomatic character of the tubercular dactylitis may explain the constant delay in the diagnosis. It is often delayed and confused essentially with bone tumors which imply histological confirmation. Objectives To study the epidemio-clinical features, stages, therapeutics and course of tuberculosis of the hand. Methods We made a retrospective study of 14 medical records of cases of tuberculosis involving the hands in an orthopedic department over the last ten years. We collected and analyzed the clinical, bacteriological, radiological and therapeutic data. Results The mean age was 45 years. There were 9 men and 5 women. A manual work was noted in 10 cases. Two patients had a diabetes mellitus and one breast cancer. The dominant side was achieved in 60% of cases. Mean symptoms duration was 3.6 months. Lesions are divided into 6 cases of pseudotumoral tuberculosis of soft tissue of the hand, arthritis and osteoarthritis in 5 cases and tenosynovitis in 3 cases. The ring and little fingers are the most affected fingers. Biopsy was done in all cases. Anti-tubercular chemotherapy was indicated for all patients: isoniazid, rifampicin, pyrazinamide and ethambutol for 2 months followed by isoniazid and rifampicin during 10 months. These antibiotics were combined with immobilization in all cases. Good outcome was seen in the 14 cases. Conclusions Tuberculosis should be suspected in cases of longstanding pain and swelling of a finger especially in an endemic area. Efficiency of anti-tubercular treatment remains undisputed. The surgical indications are limited to the biopsy, usually essential to the diagnosis. Disclosure of Interest None declared