The management of high-energy pilon fractures is still controversial. Open reduction and internal fixation are often associated with serious complications. Various methods have been used to treat these injuries, with variable results. The aim of this retrospective study was to analyze the clinical and radiographic outcome of the ILIZAROV technique in patients with high-energy pilon fractures. Thirty cases of distal tibia epiphysis fractures (pilon fractures) were managed from 1999 to 2012. The study group included 5 cases of open fractures. The mean age was 47 years. According to Rüedi and Algower classification; 11 fractures were type II, and 19 type III. All fractures were a consequence of high-energy trauma. Fractures of the lower fibula were present in 28 of the patients. An external Fixator was applied for open fractures. Closed injuries were operated on 3 to 13 days after injury, with an average of 8 days. The mean follow-up was 48 months. All fractures united. The external fixator was removed after a mean of 22 weeks (10 - 28 weeks). Two patients with a type III fracture had a delayed union and were treated with corticotomy and dynamisation of the ILIZAROV fixator. Only one secondary displacement of a type III fracture was noted after two months and was treated by adjuction of 2 olive wires. There were no cases of osteomyelitis or deep infections. Pin-tract infections occurred in ten patients. We had not any case of nervous injury due to introduction of the pins. Using radiological criteria for assessement of reduction of the articular fragments, there was excellent and good restoration of articular structure in 24 cases. The average American Orthopeadic Foot and Ankle Society ankle-hind foot score was excellent in 16, good in 6, fair in 6 and poor in 2. Soft tissue healing occurred without need for plastic surgery in all cases. The movements of the ankle ranged from 0 to 20° of dorsiflexion and 5° to 40° of plantar flexion. Twenty patients had gone back to their preinjury profession. The ILIZAROV technique is a safe and a very effective treatment for severe pilon fractures with minimum complications and good healing results.

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Introduction. Isolated fracture of the trochlea is an uncommon condition requiring a particular mechanism of injury. Its association with a distal radial fracture is rare. We aimed through this case report to identify the injury mechanism and to assess surgical outcomes. Case Presentation. We report a 26-year-old female who was admitted to our department for elbow trauma following an accidental fall on her outstretched right hand with her elbow extended and supinated. On examination, the right elbow was swollen with tenderness over the anteromedial aspect of the distal humerus. The elbow range was restricted. Standard radiographs showed an intra-articular half-moon-shaped fragment lying proximal and anterior to the distal humerus. There was a comminuted articular fracture of the distal radius with an anterior displacement. A computed tomography revealed an isolated shear fracture of the trochlea without any associated lesion of the elbow. The patient was surgically managed. Anatomical reduction was achieved and the fracture was fixed with 2 Kirschner wires. The distal radial fracture was treated by open reduction and plate fixation. The postoperative course was uneventful with a good recovery. Conclusion. Knowledge of such entity would be useful to indicate the suitable surgical management and eventually to obtain good functional outcomes.

Fractures of the radial neck accounts for 1% of all childhood fractures and 5% to 10% of childhood traumatic lesions involving the elbow. Intramedullary percutaneous nail reduction (Metaizeau technique) is considered the most effective surgical technique. The purpose of this study was to identify the main clinical features of radial neck fracture in children and to evaluate the anatomical and functional results of the Metaizeau technique. In this retrospective study, we evaluated 22 patients under the age of 16 who were treated for radial neck fracture at the orthopedic and trauma surgery department of Sahloul University Hospital in Sousse over a period of 16 years from January 2001 to April 2017. Authors used Metaizeau classification. Functional results were evaluated by Mayo elbow performance score (MEPS) and the radiological evaluation was based on standard images with measurement of the residual rocker. The average age was 8.6 years (5-13 years). Seven fracture were grade III injuries and three grade IV. In the immediate postoperative period, radiological measurements showed a residual rocker less than 20° in 86.3% and more than 20° in 13.7% of cases. At an average follow-up of 13 months and a half, the MEPS score was excellent and good for 17 patients. Four types of complications were found: necrosis of the radial head in 1 case, pseudarthrosis in 1 case, periarticular calcification in 2 cases and stiff-ness of the elbow in 3 cases. Despite the small number of patients in our series, we believe that the elastic stable intramedullary pinning according to the Metaizeau technique is the treatment of choice for displaced radial neck fractures in children.

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AIM: This research aims to study arthroscopic anchors design parameters. Prototypes were manufactured by new parameters values. The the performance of the prototypes was also tested. METHODS: Five 3D arthroscopic anchor models were created to evaluate the role of some design aspects. Thread type, pitch and tip angle were tested as variable parameters. These models were produced on engineering CAD software then imported into ANSYS for finite element analysis. A tensile load of 300 N was applied to each model while the simplified bone base was fixed-in-place as a boundary condition. The finite element results were compared with prototypes tensile testing. RESULTS: The finite element analyses showed stresses within physiological limits on the bone with all tested models. Thread type and pitch affected stresses on bone and anchor body. From stress point of view, two critical zones appeared on anchor body, anchor cortical bone connection and eyelet zone, while thread geometry (depth) affect the cortical bone response only. Laboratory tests matched finite element results and literature. CONCLUSION: Increasing thread pitch of arthroscopic anchors decreases stress on the bone, while increases stress on anchor body. Arthroscopic anchors thread type has a negligible effect on bone, while it reduces stresses on anchor body if it placed more material around eyelet in internal drive mechanism and suture eyelet type of anchors. Anchor tip angle has a negligible effect on bone and anchor body.

Introduction: Elbow dislocations are uncommon in children. The treatment and outcomes remains controversial. Materials and methods: We report retrospectively the clinical and functional results of elbow dislocations in children treated in Sahloul University Hospital. Both isolated or pure dislocations and those associated with other injuries were evaluated separately.Results: Forty-eight children were selected based on inclusion criteria. All were unilateral injuries. Pure dislocations were observed in 19 cases, out of which according to the Robert’s criteria, 13 children (68%) had excellent, three (15%) good, two (10%) fair, and one (7%)poor outcome. Out of the 29 elbow dislocations associated with other injuries, 3 (10%) had excellent, 4 (13%) good, 8 (27%) fair and 14 (50%) poor result. Reviewing the functional results, better range of motion was found in elbows with pure dislocation compared to those with associated injuries.Conclusion: Prolonged follow-up and effective rehabilitation programs are required for good outcomes.

Les tumeurs à cellules géantes des gaines synoviales (TCGGS) des tendons représentent la forme localisée de la synovite villonodulaire hémopigmentée. Elles s'observent le plus souvent au niveau des mains. Notre but était d'étudier les caractéristiques épidémio-cliniques et thérapeutiques des TCGGS, évaluer les résultats du traitement chirurgical et dégager les facteurs de récidives. Il s'agit d'une étude rétrospective de 50 cas de TCGGS de la main colligés entre 1992 et 2016 au service d'orthopédie de l'hôpital Sahloul de Sousse en Tunisie. Les caractéristiques cliniques et épidémiologiques des TCGGS ont été précisées. L'âge moyen des patients était de 33 ans (9-69 ans) avec un sexe-ratio de 0,6. Les motifs de consultation étaient l'apparition constante d'une tuméfaction (100%), la gêne à la mobilisation des articulations inter-phalangiennes (6%) et la douleur digitale (18%). Toutes les tumeurs étaient localisées au niveau de la région digitale, surtout au niveau de l'index (42%). La localisation était palmaire dans 66% des cas. Tous les malades ont été opérés, l'aspect macroscopique montrait une tumeur encapsulée, polylobée et jaune brunâtre qui se prolongeait dans la gaine des tendons fléchisseurs (4 cas) et sous le tendon extenseur (2 cas). Nous avons noté un seul cas de récidive, soit 2% qui ont été repris chirurgicalement. Les résultats fonctionnels étaient bons dans tous les cas. Le diagnostic de TCGGS doit être évoqué devant une tuméfaction digitale. Leur prise en charge fait appel à la chirurgie qui reste difficile et doit être correctement exécutée pour éviter les récidives.