M. Madhar

Dislocation of the elbow with ipsilateral forearm fracture. Six particular cases.

Elbow dislocation associated with ipsilateral radial shaft fracture is an infrequent injury (nine cases reported in the literature). We present six new cases observed between 2006 and 2012, with an average age of 31 years and a mean follow-up of 18 months. The forearm fracture and ipsilateral dislocation of the elbow were probably caused by forearm hypersupination with extension of the elbow. The dislocation was reduced by manipulation before open reduction and osteosynthesis of the forearm fracture. Four elbows were stable after reduction; two markedly unstable elbows necessitated temporary humero-ulnar external fixation; one case needed a ligamentoplasty several months later. Despite the complexity of the traumatic lesion, the clinical and radiological outcomes were acceptable.

Contribution of magnetic resonance imaging in the diagnosis of talus skip metastases of Ewing's sarcoma of the calcaneus in a child: a case report

IntroductionEwings sarcoma of the calcaneus is rare. About thirty cases with calcaneus involvement have been reported in the literature. Talus skip metastases have rarely been described in the available literatureCase presentationWe report a case of a 14-year-old Moroccan boy, who presented with Ewings sarcoma of his right calcaneus, diagnosed by swelling of the calcaneus evolving over a year. Radiography, computed tomography and magnetic resonance imaging showed an important tumoral process of the calcaneus and talus skip metastases. The diagnosis was confirmed with histology after a biopsy. In spite of amputation and postoperative chemotherapy, our patient died six months later due to secondary respiratory distress after lung metastasis.ConclusionImaging, especially magnetic resonance, is important in the diagnosis of Ewing sarcoma and skeletal skip metastases. Treatment of Ewings sarcoma consists of chemotherapy, radiation therapy and surgical resection depending on the stage and extent of the disease. With the exception of lesions in the calcaneus, the prognosis for disease-free survival of Ewings sarcoma of the foot is excellent.

Osteitis of the Fourth Metatarsal Caused by a Date Palm Thorn in a Child: Why the Dorsum of the Foot Is the Most Commonly Injured Site

The palms are frequent in the region of eastern Morocco. An insidious onset of a lytic lesion in the base of the fourth metatarsal caused by a date palm thorn in a 20-year-old patient is presented. An untreated embedded thorn can cause late complications, including periostitis or osteomyelitis. In most cases, removal of the foreign body is easy, and no surgical care is needed. If detected, these injuries can be treated without complications. In children, however, the diagnosis can be very easily missed, especially if the child has aphasia and deafness, which was present in our patient. These can influence communication between the child and family, such that the patient is unable to inform the family about what object pricked him (e.g., date palm thorn, toothpick, insect) and is unable to tell the family that the foreign object remains embedded. This major communication issue between the child and family can result in potentially avoidable complications such as osteitis. No other issues were present in our patient that could have caused a delay in diagnosis, such as fear of punishment or fear of medical treatment. We present a case of date palm thorn-induced periostitis of the base of the fourth metatarsal. Surgical exploration revealed a 2.5-cm palm tree thorn embedded in granulation tissue, forming an abscess. The lesion was successfully treated by curettage of the lesion and removal of the thorn embedded in the periosteum of the metatarsal base. The purpose of the present report was to explain the mechanism of this rare entity and the frequency of this lesion on the dorsal aspect of the foot rather than on the plantar. Despite the absence of a definite history of trauma, organic foreign material should be in the differential diagnosis of a lytic lesion of the bone, especially in patients who have a problem with deafness or aphasia.

Which approach is best for subungual glomus tumors? Transungual with microsurgical dissection of the nail bed or periungual?

Glomus tumors are rare, accounting for 1% to 5% of all hand tumors. The treatment of subungual glomus tumors consists of complete surgical excision, either by the periungual or transungual approach. Tumor recurrence and nail dystrophy are the main complications. The purpose of this study was to evaluate the outcome as a function of the surgical approach used - transungual or periungual. Fifty-three patients presenting with a subungual glomus tumor underwent surgical excision through the periungual approach if the tumor was peripheral, or the transungual approach if the tumor was centrally located. These patients were followed for an average of 2years. Pain relief was always obtained the day following surgery. Wound healing was achieved on average after 2weeks with the periungual approach and 5weeks with the transungual approach. Other than some longitudinal striations in 10 patients (18.9%) who had been operated through the transungual approach, there were no complications or tumor recurrence. We recommend a periungual approach for a peripheral tumor and a transungual approach for a central tumor. The latter approach, which carries some risks of nail-related sequelae--always minor in our experience--allows for better exposure if the tumor is centrally located.

Primary subcutaneous hydatid disease of the forearm

Echinococcosis is a widespread zoonosis that is endemic in most sheep-raising countries. However, with increased international travel, hydatid disease can be present in any part of the world. The infestation usually involves the pulmonary and digestive systems, but it occasionally affects other organs. Primary hydatid cysts of muscle are uncommon [1,2]. Here, we present a case of primary subcutaneous hydatid disease of the forearm.

Floating thumb metacarpal in a motorcyclist: A case report

We present a case of simultaneous dislocation of the carpometacarpal and the metacarpophalangeal joints of the thumb (floating thumb metacarpal) in a 47-year-old motorcyclist. The treatment consisted of closed reduction of both joints with cast immobilization. After 24 months, the functional result was excellent. The mechanism of this rare injury and its therapeutic management are discussed.