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Ali A Al-Omari,1 Anas AR Altamimi,2 Esra’a ALQuran,3 Abed Allah Ahmad Saleh,1 Qusai Mustafa Alyafawee,1 Mohammad Ziad Audat,4 Khaldoon Bashaireh1 1Department of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 2Department of General and Specialized Surgery, Faculty of Medicine, Hashemite University, Zarqa 13133, Jordan; 3Department of Pathology, Faculty of Medicine, Jordan University of Science and Technology, Irbid 22110, Jordan; 4King Abdullah University Hospital, Jordan University of Science and Technology, Irbid 22110, JordanCorrespondence: Ali A Al-OmariDepartment of Special Surgery, Division of Orthopedics, Faculty of Medicine, Jordan University of Science and Technology, P. O. Box: 3030, Irbid 22110, JordanTel +962 796903766Fax +962 2 7201064Email dr.ali.omari80@gmail.comBackground: Spontaneous rupture of extensor pollicis longus (EPL) tendon is a rare condition often found in patients actively having regular extensive use of hands and fingers especially the thumb. In this article, we report 7 cases of spontaneous rupture of EPL tendon and investigate the associated factors and treatment outcome.Methods: Retrospectively, the databases for the 7 cases were retrieved and studied. These cases represent all cases of spontaneous rupture of EPL in our institution. Demographic data, clinical presentation, any history of trauma or steroid injection, laboratory and clinical findings suggestive for rheumatoid arthritis, co-morbidities and imaging findings were obtained. In addition, the operative technique and findings were retrieved. Moreover, histopathological studies and follow-up assessment were included.Results: Six males and one female were included. The mean age was 45.2 years. No prior history of trauma, rheumatological disease or steroid use was detected in any patient. All patients experienced prodromal pain in the radial side. Clinical examination was the most effective diagnostic measure. Magnetic resonance imaging (MRI) was used to confirm the diagnosis and to look for other abnormalities that may predispose to rupture. Five patients underwent extensor indicis proprius to EPL tendon transfer employing Pulvertaft weave technique and one patient underwent primary repair as there was a little gap in the tendon ends. In this study, one patient refused any treatment. All patients achieved a favorable outcome at the last follow-up.Conclusion: Diagnosis of spontaneous ruptures of EPL tendon can be confirmed through clinical examination and MRI for patients with restricted thumb movement even with the absence of any identifiable predisposing risk factor. During surgery, detailed attention must be drawn towards the tendon ends which can have unusual gaps and bone abnormalities.Keywords: thumb, interphalangeal joint, rheumatoid arthritis, tendon, extensor pollicis longus

Introduction: Osteochondroma is the most common benign bone tumour which can be solitary or multiple. Although usually asymptomatic, its associated deformities and secondary malignant transformation potential might be associated with significant morbidity and mortality. There are significant variations of different clinical aspects of osteochondroma among different populations, which might be related to different population characteristics including genetic variance. Aim: To review the clinical features and management characteristics of Osteochondroma among Jordanian patients and to compare these features with other populations. Materials and Methods: This was a retrospective study in which the medical records of all osteochondroma patients who had undergone surgery for one or more lesions over the period from March 2004 till June 2017 were reviewed. A total of 88 patients with a confirmed histopathological diagnosis of osteochondroma were included. The following information was collected; age, gender, location, imaging studies, indications for surgery, operative procedure, complications and recurrence. Results: Solitary Osteochondroma (SO) was four times more common than Multiple Osteochondromas (MO). In SO, male/ female ratio was 2/1, 69% (48/70) of patients presented before the age of 20 years. 4.3% (3/70) had recurrence after excision, 1.4% (1/70) had corrective osteotomy. In MO; male/female ratio was 1.25/1, 89% (16/18) presented before the age of 20 years, 2.2 (39/18) was the average number of tumours per patient, 50% (9/18) had a positive family history, 5.6% (1/18) had corrective osteotomy and none had a recurrence. Tumours around the knee were the most common location in both groups. X-ray was the only imaging study in two-third of tumours. Common indications for surgery included mass (49/109) and pain (39/109). Rare indications included; vascular claudication (1/109), soft tissue osteochondroma (1/109), and bursa formation (2/109). Neither group had a post-resection fracture nor a secondary chondrosarcoma transformation. Conclusion: In this series, there was a low over all risk of recurrence, post-resection fracture and secondary malignant transformation. Compared to other populations, Jordanian Osteochondroma patients presented a mild form of MO with low number of tumours in each patient (p-value =0.01) and low risk of associated deformities (p-value=0.025). Hence, we recommend a conservative resection approach for osteochondroma especially in anatomically inaccessible locations.

Background Synovial sarcoma is a rare soft tissue sarcoma which most commonly affects the extremities of young adults. Axilla involvement by this sarcoma is very rare especially with involvement of the brachial plexus. This combination adds to the challenge in approaching such tumors which might significantly affect survival and function. Case presentation Herein, we present a 48-year-old female patient who presented with an isolated painless lump in her right axilla. Initially, her workup, looking for possible breast cancer, included fine-needle aspiration (FNA) which did not provide the diagnosis. Core-needle biopsy, performed later, revealed monophasic synovial sarcoma. Her workup studies revealed no metastasis. Then, through extensile deltopectoral approach, the tumor was dissected out from within the brachial plexus. Ulnar nerve was sacrificed in order not to compromise the surgical margins which were confirmed tumor free by final pathology. The patient did not receive chemotherapy or radiation upon consultations with medical and radiation oncology teams. Her follow-up revealed no tumor recurrence with no restriction of her right shoulder motion. Conclusion Our case report represents a very rare occurrence of synovial sarcoma in the axilla with involvement of the brachial plexus. When clinical and radiological findings are suggestive of soft tissue sarcoma of the axilla, we recommend getting core-needle biopsy rather than fine-needle aspiration for earlier diagnosis. Early referral and multidisciplinary approach may contribute to better management.

Pertrochanteric femur fractures are considered amongst the most commonly encountered fractures in the geriatric age group. We evaluated radiographic and functional outcomes of patients with unstable pertrochanteric fractures treated with the proximal femur nail antirotation (PFNA). Between March 2013 and December 2015, fifty patients (28 male and 22 females with a mean age of 72.8 years (range, 20–94)) with unstable pertrochanteric fractures (AO 31.A2 and 31.A3) were fixed with the PFNA at our institution, and they were retrospectively evaluated. Forty one patients were treated with short PFNA and nine with long PFNA. Operative time ranged between 30 and 150 (average 73.60) min, blood loss ranged between 50 and 250 (average 80) milliliter and hospital stay ranged between 3 and 18 (6.86) days. The mean follow-up period was 18 months (range, 11–31). At final follow-up, solid union of all fractures had been achieved without any implant-related complications, the mean Harris Hip Score (HHS) was 79.34 ± 9.10 points and the mean neck-shaft angle was 127.2° ± 5.07°. No significant differences were encountered between the functional and radiographic outcomes of the PFNA with regards to the AO fracture classification and the implant version. PFNA is a recommended option for the treatment of unstable pertrochanteric fractures owing to its easy insertion, reduced blood loss, stable fixation and satisfactory functional and radiological outcomes.