Dislocation of the metacarpophalangeal joint is a rare injury. The index finger is most frequently involved, followed by the thumb; the little finger is very seldom affected. The Complex dislocation of the little finger metacarpophalangeal joint is extremely rare. A few cases only had been described. Herein, we report a case of 40 years old presented, after a road accident, a dorsal metacarpophalangeal joint dislocation of the litter finger confirmed on radiographs with a clear view of the sesamoid bone within joint prompting the patient to undergo open reduction with no attempts of closed reduction initially. We elected, to treat our case, for the volar approach which allowed successful relocation of the head of the metacarpal in its anatomical position. The view of sesamoid bone within the joint is pathognomonic of volar plate entrapment. Recognition of this fact should alert the treating physician to the inevitability of open reduction for anatomical repositioning of the joint and avoid repeated attempts at closed reduction which may arise the risk of degenerative arthritis and reduced final range of motion.
The incidence of bone tuberculosis is less than 5% of all tuberculosis cases. Furthermore, multifocal bone tuberculosis is uncommon, which rarely occurs without primary foci. It is difficult to diagnose, particularly if it is localized in both humeral heads. On the other hand, the isolated iliac bone tuberculosis is exceptional; it constitutes, also, a challenging diagnosis, which requires a high index of clinical suspicion and advanced investigations. Herein, we first report a case of multifocal tuberculosis of both humeral heads with no primary foci, and we secondarily report a case of isolated iliac bone tuberculosis. At last, however, the histological exam and polymerase chain reaction for the Mycobacterium tuberculosis complex are not always positives; they are mandatory as tests to ascertain the diagnosis.
To the best of our knowledge, the case presented here is among the rare cases of simultaneous shoulder dislocation and ipsilateral pallet humeral fracture, and we discuss its mechanism and best management. We report a case of a 26-year-old male patient with a history of dislocation of the right shoulder 2 months prior to trauma, managed conservatively with a good outcome. The patient fell from a height of 2 m, which caused concomitant shoulder dislocation and ipsilateral humeral fracture, prompting him to undergo surgery. First, the shoulder dislocation was reduced, and second, a V-shaped olecranon osteotomy was performed. The fracture was then fixed using two compressing plates followed by adequate rehabilitation, which led to a good outcome. This rare combination, if it occurs, requires urgent management to save the functional prognosis of the limb.
Schwannomas represent only 5% of all soft tissue tumors. As a variant of this tumor, the plexiform schwannoma is rare accounting for less than 5% of all schwannomas. Herein, we report a rare case of a 49-year-old athlete who suffered from a pain in the posterior aspect of the right leg one year before his presentation. Initially, a radiograph of his right leg showed no abnormality, and so, the emergency physician discharged him on analgesics and anti-inflammatory medications, and rest was advised. The persistent pain obliged the patient to consult our orthopedic department. On examination, we found a firm mass in the proximal medial aspect of his right leg. The neurovascular exam was normal. Sonography of the leg was not conclusive. Therefore, magnetic resonance imaging was performed, and a hemangioma or schwannoma was suspected. The patient underwent surgery in which the entire tumor mass was shelled out in one piece with no damage. The histopathological finding was concomitant with a plexiform schwannoma. Follow-up evaluation, sixteen months later, showed no evidence of recurrence, and the patient has regained his previous level of sportive activities. So, given the case described here, despite the rarity of the schwannoma, it should be taken into consideration as a possible diagnosis in such situation to promote early diagnosis and appropriate treatment.
Almost 2% of all emergency admissions involve an animal bite. While horses bite humans very rarely, their bites are mostly associated with fatalities. Herein, we report the case of a 23-year old bitten by a domestic horse causing a crush injury to his fourth finger with fracture dislocation of the proximal interphalangeal joint. The patient benefited upon arrival at the emergency department from copious irrigation with saline serum, tetanus toxoid, postexposure rabies vaccination, and prophylactic antibiotic therapy. In the operating room, surgical exploration found the ulnar digital pedicle sectioned, the flexor and extensor tendons sectioned and shredded, and the skin shredded. An excisional debridement of devitalized tissue with copious irrigation was performed, and the finger regularized at the level of traumatic amputation with tendon striping followed by coverage of the bone by the radial digital flap with careful clinical and biological monitoring after the surgery. At the last follow-up, the patient revealed no sign of infection, and he returned to his usual activities and has been discharged from care. This wound management, based on a careful examination, a meticulous debridement, and an efficient cleaning with early and targeted antibiotic therapy, might promote good results and avoid dangerous complications.
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