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Abstract Objective The purpose of this study was to describe a surgical technique of bone resection with periosteal preservation and reconstruction in patients with high-grade bone malignant tumors and to determine its effect on local recurrences, and time and quality of bone union in bone autografting reconstruction. Patients and methods We retrospectively reviewed 11 cases of high-grade malignant bone tumors in children aged 4 to 16 years, who were treated with chemotherapy and tumor resection while preserving partially the adjacent periosteum. Tumors were located in the lower limb in eight cases; three tumors were in the humerus. The mean length of the bone defect after resection was 15.8 cm (range, 6–34.5 cm). Reconstruction was provided by non-vascularized autograft in eight cases (lower limb) and polymethyl methacrylate spacer in three cases (upper limb). Patients were followed up for a mean of 71 months. Results At the last follow-up, no patients had local recurrence. Three patients were dead because of metastasis. Bone union was good in time and quality in all children who had bone autografting. In cases of PMMA reconstruction, there was periosteal bone formation around the spacer. According to the MSTS functional score, patients with lower limb localizations had a mean score of 27.75 points and patients with upper limb localizations had a score of 24/30. Conclusion Preservation of the periosteum in bone resection for malignant tumors could be a good adjuvant alternative for bone reconstruction, without increasing the risk of local recurrence. However, patients must be carefully selected.

Claudication of the young patient is a very rare symptom for orthopaedic surgeons and it is often overlooked. We report a rare case of popliteal artery entrapment syndrome (PAES), discovered during a vascular claudication following post-traumatic anterior instability of the knee. The diagnosis was confirmed by CT angiography which showed a PAES, with a pathway in the inter-condylar notch. The patient had a releasing of the trapped vessel by myomectomy, with disappearance of vascular symptoms six months later. Through this case, we wanted to draw the attention of orthopaedic surgeons to the fact that the PAES can be asymptomatic. Its symptomatology can be triggered by a traumatic instability of the knee. Its presence represents a risk of lesion of the popliteal artery during arthroscopic ACL reconstruction. Therefore, it is important to think about this disease if a calf pain occurring after a ligament injury of the knee.

La maltraitance physique des enfants ou le syndrome des enfants battus est responsable de plus de 75.000 décès par an en France. Ce problème de santé publique reste sous diagnostiqué en Tunisie et dans le monde. Le chemin a été laborieux pour la reconnaissance du syndrome des enfants battus dans certaines sociétés même occidentales. Nous avons voulus exposer ce problème aux praticiens afin quéil soit mieux diagnostiqué et pris en charge. La maltraitance physique des enfants est appelé à tort syndrome de Silverman qui ne regroupe en fait que les lésions squelettiques chez ces enfants tels que les fractures.

In this study, we describe a 4-year-old boy with a head, cervical, and left shoulder injury following the reception of a heavy metallic door on his left side that resulted in SCIWORA. SCWORA is defined as spinal cord injury without x rays or CT scans lesions but can be detectable on RMI scans. SCIWORA follows trauma, sometimes trivial. The management consists of immobilization and nursing. The clinician should be aware of this entity. We are reporting the management of a four years old boy. [ABSTRACT FROM AUTHOR]

Primary pleomorphic liposarcoma of bone is an exceedingly rare sarcoma. We herein report the case of a primary pleomorphic liposarcoma of the distal femur in a 20-year-old female patient. Magnetic resonance imaging showed a 25.4-mm medullary necrotic tumor process in the lower third of the distal right femoral meta-diaphysis that was weakly enhanced after gadolinium injection. The patient first underwent an open biopsy. Microscopically, a pleomorphic liposarcoma were suspected. Immunohistochemically, tumor cells expressed the S-100 protein. Fluorescent in situ hybridization showed the absence of MDM2 gene amplification and the absence of EWING/PNET translocation. The diagnosis of primary pleomorphic liposarcoma of the bone was then retained. A wide resection and chemotherapy were performed. The patient died of liver metastasis after 8 months of follow-up. Primary pleomorphic liposarcoma has no specific clinical or radiological findings. Histological diagnosis and molecular study are crucial tools for making an accurate diagnosis. • Primary pleomorphic liposarcoma of the bone (PPLB) is exceedingly rare, representing <0.1% of primary bone tumors. • Radiological features are not specific. • Tumor cells strongly express S-100 protein with absence of MDM2 gene amplification and the absence of EWING/PNET translocation in FISH. [ABSTRACT FROM AUTHOR]

Proximal tibia without its periosteum and only the previous site of biopsy was resected with the tumor (footnote: star: anterior tibial tuberosity). The distal fibula tumor was removed (at the same surgical time) (footnote: star: periosteum preserved). 2A Ewing sarcoma of the distal right fibula with purely intraosseous second localization in the homolateral proximal tibia in a 9-year-old boy. [Extracted from the article]

Osteochondromas mainly affect the metaphysis of long bones such as femur, humerus, and tibia. It is unusual in flat bones such as scapula. Osteochondroma of ventral surface of scapula is one of the rare cause of shoulder pain and difficult to diagnose in first place. We report the case of an 18-year old girl, presenting progressive right shoulder pain for two years. Physical examination showed an imbalance of the shoulders, a winging of the right scapula, and a snapping of the shoulder on mobilization. Radiographic evaluation showed a pedunculated bony structure extruding from the scapula. Computed tomography (CT) scanner and magnetic resonance imaging (MRI) revealed a bony exostosis along the medial border on the ventral surface of the right scapula. The patient had an excision of the exostosis. Histologic examination confirmed that the specimen was an osteochondroma with no signs of malignant transformation. The shoulder was immobilized for two weeks. The patient has regained full function of her shoulder, six weeks postoperatively. [ABSTRACT FROM AUTHOR]

Claudication of the young patient is a very rare symptom for orthopaedic surgeons and it is often overlooked. We report a rare case of popliteal artery entrapment syndrome (PAES), discovered during a vascular claudication following posttraumatic anterior instability of the knee. The diagnosis was confirmed by CT angiography which showed a PAES, with a pathway in the intercondylar notch. The patient had a releasing of the trapped vessel by myomectomy, with disappearance of vascular symptoms six months later. Through this case, we wanted to draw the attention of orthopaedic surgeons to the fact that the PAES can be asymptomatic. Its symptomatology can be triggered by a traumatic instability of the knee. Its presence represents a risk of lesion of the popliteal artery during arthroscopic ACL reconstruction. Therefore, it is important to think about this disease if a calf pain occurring after a ligament injury of the knee. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to determine the influence of polymorphisms in some key gene actors of the vitamin D (vitD) metabolic pathway on supplementation efficacy. Methods: In total, 245 healthy participants were recruited from occupational medicine service in Sahloul University Hospital with vitD deficiency [25(OH)D ≤ 30 ng/ml]. After giving an informed consent, all participants were asked to complete a generalized questionnaire and to follow a detailed personalized supplementation protocol. Genetic study was performed by PCR-RFLP for 15 single nucleotide polymorphisms (SNPs) belonging to DBP, CYP2R1, CYP27B14, CYP24A1 and VDR genes. Statistical study was carried out with SPSS23.0. Results: Among the studied SNPs, non-response was significantly associated with variant alleles of rs4588 (OR* = 11.51; p < 0.001), rs10766197 (OR* = 6.92; p = 0.008) and rs12794714 (OR* = 5.09; p = 0.004). These three SNPs contributed in 18.8% in response variability with rs4588 being the most influential (10.3%). There was a significant linear negative correlation between baseline 25(OH)D and post supplementation 25(OH)D concentration (r = −0.437; p < 0.001) as well as a linear negative association between the increase in 25(OH)D concentration and GRS (GRS: genetic risk score = the sum of risk alleles) (r = −0.149; p = 0.033). Conclusions: DBP-rs4588, CYP2R1-rs10766197 and rs12794714 variants are associated with variations in serum 25(OH)D concentrations and efficacy of response to vitD supplementation in Tunisian adults. Taking into account these variations can help to better adapt vitD intake to ensure a higher response to supplementation. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to describe a surgical technique of bone resection with periosteal preservation and reconstruction in patients with high-grade bone malignant tumors and to determine its effect on local recurrences, and time and quality of bone union in bone autografting reconstruction. Patients and methods: We retrospectively reviewed 11 cases of high-grade malignant bone tumors in children aged 4 to 16 years, who were treated with chemotherapy and tumor resection while preserving partially the adjacent periosteum. Tumors were located in the lower limb in eight cases; three tumors were in the humerus. The mean length of the bone defect after resection was 15.8 cm (range, 6–34.5 cm). Reconstruction was provided by non-vascularized autograft in eight cases (lower limb) and polymethyl methacrylate spacer in three cases (upper limb). Patients were followed up for a mean of 71 months. Results: At the last follow-up, no patients had local recurrence. Three patients were dead because of metastasis. Bone union was good in time and quality in all children who had bone autografting. In cases of PMMA reconstruction, there was periosteal bone formation around the spacer. According to the MSTS functional score, patients with lower limb localizations had a mean score of 27.75 points and patients with upper limb localizations had a score of 24/30. Conclusion: Preservation of the periosteum in bone resection for malignant tumors could be a good adjuvant alternative for bone reconstruction, without increasing the risk of local recurrence. However, patients must be carefully selected. [ABSTRACT FROM AUTHOR]

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