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Purpose: To gain insight into safety and efficacy of in situ and ex-situ fenestration techniques for total endovascular arch repair. The term ex-situ fenestration is referring to physician-modified stent-graft technique where fenestration is performed on a back table., Methods: Electronic search was conducted according to PRISMA (Preferred Reporting Items for Systematic review and Meta-analyses) guidelines from 2000 to 2020. The main outcomes measured were 30-day mortality, stroke, aortic-related mortality, and reintervention rates., Results: Fifteen studies were eligible: 7 ex-situ fenestration (189 patients) and 8 in-situ fenestration (149 patients). In ex-situ group, dissection was the main pathology treated and proximal sealing zones were Z0 or 1 in 53.5% of patients. In in-situ group, dissection and aneurysm were equally represented in around 40% of cases and proximal sealing zones were Z0 or 1 in 46.5% of patients. Cumulative 30-day all-cause mortality was similar in both groups: 3.8% (95% confidence interval [CI]: 1.7%-8.2%) and 3.8% (95% CI: 1.6%-8.9%), respectively, in ex-situ and in-situ groups and stroke rate of 2.8% (95% CI: 1.1%-7%) and 5.3% (95% CI: 2.6%-10.5%). After a 11.1 ± 2.6 months mean follow-up for ex-situ and 16.7 ± 2.3 months for in-situ group, there were 5.2 and 1.4 reinterventions per 100 patients-years, respectively, for ex-situ and in situ groups. Aortic-related mortality rates of, respectively, 3.2% (95% CI: 1.3%-7.4%) and 2.6% (95% CI: 0.9%-7.3%) were noted in ex-situ and in situ groups., Conclusion: The reported data show favorable short-term results of both ex-situ and in-situ fenestration techniques with low mortality and strokes rates. However, durability is still questionable given the lack of long-term data. Both options may have their place in arch repair beyond the spectrum of emergent and urgent cases, on condition that results stand the test of time., Clinical Impact: In situ and ex-situ fenestration techniques have been initially developed to overcome emergency or as a bail out techniques however giving the promessing favorable short term results indications of these techniques may be extended to elective patients ineligible to customized stent-grafts and possibly in the futur to more elective cases as an option for total endovascular arch repair., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Hydatidosis is a parasitic disease due to Echinococcus granulosus. Spinal hytatidosis is the most common form, characterized by high morbidity and mortality. It is often diagnosed only when neurological complications occur, due to the long clinical latency and the non specific nature of symptoms. Standard radiography may show lacunar, areolar abnormalities separated by irregular walls without clear boundaries. Magnetic resonance imagery can reveal hydatic abcess presenting typical liquid abcess and locoregional extension. Laboratory methods are of little assistance to the diagnosis. Complete surgical excision of the lesions remains the only curative treatment, in the same way as for malignant tumors. Surgical eradication of hydatic lesions is difficult, however. Indeed, the surgeon is guided by the macroscopic aspect, but the bone may be infiltrated by microvesicles without clear boundaries. It is now recommended to accompany surgery by medical treatment based on albendazole. Rapid diagnosis and treatment of spinal hyatidosis may yield long-term remission or even cure, especially in localized forms.

Background: Sub-occipital Pott's disease is rare, but dangerous., Aim: To recall diagnostic aspects and spatially the neuroradiological ones of sub-occipital Pott's disease., Methods: We describe three patients with sub-occipital Pott's disease followed in our department from 2002 to 2007., Results: There were two women and one man (mean age at onset: 48 years). The early clinical picture was non specific. Exploration, in addition to standard radiographies included a computerized Tomography (CT) (n=2) and MRI (n=1 and n=3). The diagnosis was confirmed histologically on a biopsy of the abscess (n=1), a bacteriological evidence (n=2) and retained thanks to argument presumption (n=3). The treatment was based on quadruple antituberculous chemotherapy with external traction (n=2 and n=3) associated with urgent surgery (n=1) because of the worsening of the neurological complications. The evolution was fatal (n=1) and positive (n=2 and n=3)., Conclusion: Tuberculosis should be suspected in patients with chronic torticollis and residing in an area when tuberculosis is endemic. Medical treatment is based on a quadruple antituberculosis chemotherapy with traction in the presence of atlanto-axial instability. Surgery is reserved in case of neurological worsening or persistent instability.

Background: The first metatarsophalangeal joint arthrodesis is a fusion with optimal alignment of the first metatarsal and first phalanx which conferring indolence, strength and stability., Aim: The goal of this study was to evaluate the place of arthrodesis of the first metatarsophalangeal joint in surgery of the fore foot., Methods: This work is based on analysis of records of 35 patients between 1995 and 2006. 39 first metatarsophalangeal joint arthrodesis were practice (3 were bilateral). They had a follow up of from three to ten years. All patients were called for a complete exploration radiographic and clinical evaluation according to the criteria of KITAOKA. The average age of patients was 54 years., Results: They were 28 women and 7 men. The indications were hallux rigidus in 51% cases and rheumatoid arthritis in 41% cases. The procedure used mostly a stable fixation with a compressive screw. The dorsal flexion recommended is between 20 and 30°. Ankylosis of the ankle or the inter-phalangeal joint was an against indication for the first metatarsophalangeal joint arthrodesis. The study found a patient subjective satisfaction rate of 92 per cent, there was no pain for 89 per cent of cases. It was noted 4 non-fusion cases paradoxically with satisfactory functional result. There was no pain of inter-phalangeal joint in all cases when X-rays showed arthritis in 4 cases., Conclusion: The first metatarsophalangeal joint arthrodesis, provided we respect a few simple principles, restores painless and satisfying function of foot.

Lumbosacral dislocation is uncommon. We report a case of traumatic lumbosacral dislocation which occurred in a 33-year-old pedestrian traffic accident victim. The posterior impact produced lumbar injury with diffuse pain exacerbated at the lumbosacral junction. Ecchymotic diffusion involving the entire lumbar region fluctuated due to the presence of a subcutaneous hematoma. The neurological examination revealed incomplete L5 paraplegia. Standard x-rays revealed L5-S1 spondylolisthesis and fracture of the L5 spinous process as well as fractures of the L3, L4, and L5 transverse processes. Computed tomography disclosed biarticular L5-S1 fracture dislocation and a voluminous herniation of the L5-S1 disc. Emergency surgery was performed and revealed subaponeurotic detachment from T4 to S1 and bald iliac pyramids. After L5 laminectomy and extraction of the voluminous herniation of the L5-S1 disc, a short L5-S1 posteriolateral fusion was achieved using pedicular screws and two rods on either side as well as a posterolateral iliac autograft. The clinical course was satisfactory with nearly complete neurological recovery (persistent levator ani paresis). This clinical case and a review of the literature illustrate the pathogenic, clinical, radiological and therapeutic aspects of lumbosacral fracture dislocation.

Objective: To report a case of spontaneous gluteus medius tear repaired surgically in a 42-year-old woman patient without any other antecedent other than diabetes. PATIENT AND METHODS-RESULTS: Trochanteric pain evolving for 7 months led to scintigraphy objectifying a hyperfixation of the trochanter and ultrasonography showing an inflammatory gluteus medius tendon. These examinations were supplemented by magnetic resonance imaging and tomodensitometry visualising the tendon rupture but no marked fat degeneration of the muscle despite atrophy of this one. Surgical exploration confirmed the presence of a major rupture of the gluteus medius tendon, which was reinserted through an osseous trench. Rehabilitation involved protecting the tendon, by an installation of the member in abduction and passive mobilization from the third postoperative day, with a move to partial support on day 45. The result after 16 months was excellent, the patient returning to work 8 months after the surgery without any residual pain., Conclusion: The spontaneous rupture of the gluteus medius, often ignored, can occur in young subjects and induce limited function, often well corrected by reinsertion surgery.

Central chondrosarcoma of the tibia is exceptional, particularly in young patients. Low-grade tumors raise difficult problems for histological distinction with enchondroma. We report a case of grade 1 chondrosarcoma located in the upper portion of the tibia in a 17-year-old girl. After radical surgery, outcome was favorable with no recurrence or metastasis at three years follow-up. The distinction between low-grade central chondrosarcoma and enchondroma is one of the most difficult challenges in bone pathology. Clinical, radiographic and pathological data must be considered together to reach certain diagnosis.

Transverse fractures of the sacrum with major displacement are rare and often misdiagnosed. A case of transverse fracture of the sacrum with cauda equina injury is reported. The diagnosis was not recognized initially. Conventional radiographs of the pelvis failed to demonstrate the fracture. True lateral sacral views and CT scan with reconstructions allowed analysis of the different sagittal fracture lines to facilitate surgical planning. These examinations should be considered in all patients with history of high energy trauma and clinical signs indicating lumbosacral injury.

On the basis of a retrospective study comprising 91 cases of femoral neck fracture treated by DHS, unrecognized screw articular penetration was observed in 9 cases (9.9%). The coxa valga (Garden I) fractures are the most interested by this complication (7 cases out of 9). With a practical purpose and to avoid remarking each time complex measurements again we found that the distance "d" separating the end of the implant from subchondral bone calculated on antero posterior and lateral views and so the angle measured on the lateral view were two criteria significantly predictive of this technical error with respectively P: 0.005 and P: 0.0005. Thus during the surgical procedure taking these two measurements after the installation of the pin guide would allow attention on the risk incurred. In case of doubt, we have changed the way of this pin before resorting to drilling and tapping.

The authors report a case of Fielding type II acute atlanto-axial rotatory fixation (AARF). The CT scan with coronal reconstruction showed an avulsion of the apical and right alar ligament. These findings are exceptionally reported in the literature, especially concerning the apical ligament which might be a stabiliser in flexion and extension of the occipitocervical joint.

The authors present a rare case of univertebral hydatidosis, and report encouraging results 12 years after radical resection of the involved vertebra. They stress the importance of computed tomography and especially magnetic resonance for monitoring early recurrence. A two-staged anterior and posterior approach, although difficult, seems to offer a very good prognosis in case of univertebral localisation.

We report a case of subchondral osteoid osteoma of the tarsal navicular bone. Osteoid osteomas are often located in the foot, mainly in the talus. This is the first report in the literature of a tarsal navicular bone localization. Diagnosis was difficult and established late due to misleading clinical presentation simulating mediotarsal arthritis.

Background: The principle danger of pharyngeal abscess is the risk of rupture overflow into the upper respiratory track. Pyogenic abscesses are the most frequent and tuberculosis is rare. We report two cases of retro and parapharyngeal abscesses with tuberculous spondylodiscitis., Case Reports: The first case occurred in a 54-year-old woman, the second in a 19-year-old man. Both had a laterocervical swelling associated with a oropharyneal bulge that progressed over several months. Computed tomography showed abscess formation and spinal disease in both cases. Drainage of the abscess led to the distological diagnosis of tuberculosis. Medical management was successful with resolution of the abscess and spinal lesions., Discussion: Spinal tuberculosis should be suspected in patients with a parapharyngeal abscess without detectable portal that progresses slowly. A biopsy specimen is required for diagnosis. Magnetic resonance imaging can provide early evidence of spondylodiscities. Medical treatment is indicated.

Osseous hydatidosis is a rare occurrence of hydatid disease. Anatomoclinical changes are, however, peculiar to this localization. From the anatomopathologic standpoint, this localization marks the torpid, insidious progression of the parasite into bone tissue, leading to an immediate diffuse, extensive, invasion process, so complete surgical eradication is rarely possible. From the clinical standpoint, whatever the localization may be, we are surprised by the latency of this affection, the patient being treated at an advanced stage, when radiologic lesions are already extensive, and the complications, especially in the spinal area, are severe. Owing to the poor biologic findings, the diagnosis of osseous hydatidosis is still primarily based on roentgenographic findings. Sometimes, however, the diagnosis is established only after surgery. Treatment of osseous hydatidosis is closer to oncologic therapy than to the usual surgical treatment of visceral hydatid cysts. Because of the poor results with medical treatment, osseous hydatidosis must be treated by a radical operation with wide excision, adapted to each localization. In the main, the prognosis of osseous hydatidosis remains poor, especially with spinal and pelvic localizations, which are the most frequent ones. The prognosis and treatment of osseous hydatidosis belong in the same category as a locally malignant lesion.

Three patients (2 females, 1 male) with a mean age of 51.4 years receiving long term hemodialysis affected by tumoral calcinosis were analysed. Clinical, radiological and pathological features were evaluated and pathogenic were reviewed. The joints involved int the cases presented in this report were the hip shoulder and finger. The lesions were bilateral in shoulder. An increased calcium-phosphorus product (Ca x P) was observed in all patients with secondary hyperparathyroidism in one case. Surgery was carried out in all patients. No relapse of the tumoral calcinosis was observed after surgery. The most important pathogenic factor involved in uremic tumoral calcinosis is an increase in calcium-phosphorus product (Ca x P) not necessarily related to hyperparathyroidism. Therefore, maintaining the calcium x phosphate product within the normal range appears to be the most important factor ito prevent the appearance of uraemic tumoral calcinosis.

The authors report a case of a synovial lipoma of the knee in a 40 years old man who suffered from chronic instability of the right knee associated to an extensive joint swelling and recurrent hydarthrosis. Ultrasonography and arthrography showed a synovial process and the computerized tomography showed an inhomogeneous low density due to its fat content suggesting a synovial lipoma arborescens of the knee. Final diagnosis was confirmed by histological examination of the arthroscopic biopsy. The authors discuss, through out their case and a review of the literature, modern investigation findings and indication for surgical treatment of this disease.

This paper presents a short study of 17 cases of tuberculosis of the greater trochanter seen during a period of 19 years at the National Orthopaedic Institute in Tunis. The onset of the infection is slow with patients presenting at a mean of 7 years after initial symptoms. The diagnosis is confirmed by biopsy and culture of the organism. Management is based on treatment with antituberculous drugs, although surgical excision of the lesion is sometimes required. Successful resolution of the symptoms is usually achieved unless the hip joint becomes involved. Our patients showed good results at a mean follow up of 5 1/2 years.

An exceptional case of vertebral hydatidosis with involvement of the cervical, dorsal, lumbar and sacral segments of the spine is presented. Vertebral hydatidosis is a rare form of hydatid disease. It is found in less than 2% of all cases in echinococcosis. The initial parasite localization is usually univertebral. Extensive primary lesions were related to massive infestation by tapeworm ova at multivertebral levels. At this stage, the disease presents as a malignant tumor resistant to all surgical procedures. The prognosis is poor because of severe neurological complications and inexorable spinal destruction. The hope remains that in the future an effective medical parasiticidal treatment will be available.