No abstract

BACKGROUND: Trochanteric fractures are frequent and mainly affect the elderly causing autonomy loss. Their incidence is increasing, and they are associated with substantial morbidity and high cost. AIM: The aim of our study was to identify epidemiological, radiological, and technical predictors of failure of trochanteric fracture fixation in the elderly. METHODS: We conducted a retrospective study including 188 patients aged over 65 years, who underwent surgery for trochanteric fractures, in the period between 2015 and 2020 at the orthopedics department of the Military Hospital of Tunis. The minimum follow-up was 12 months. RESULTS: Thirty-four patients had a mechanical failure (18.1% of cases), including 12 cases of cephalic screw migration (CSM) (6.4%), 12 cases of disassembly (6.4%), eight cases of malunion (4.3%), and four cases of non-union (2.1%). Bone fragility with a Singh index ≤III was associated with CSM, disassembly of fixation material, and malunion (respectively, p < 0.001; p = 0.01 and p = 0.044). Reduction quality was associated with disassembly (p < 0.001) and CSM (p = 0.004). Eccentric screw positioning on anteroposterior (p < 0.001) and lateral views (p = 0.018), high tip-apex distance (TAD) (p < 0.001), and calcar-referenced TAD (p < 0.001) were predictive of CSM. Logistic regression analysis showed that poor reduction quality was an independent factor associated with the occurrence of mechanical complications. Functional outcomes were assessed using Parker and Postel Merle d’Aubigné scores. CONCLUSION: To minimize the risk of mechanical complications, the surgeon must pay close attention to the fracture reduction and to the correct positioning of the cervical screw.

No abstract

BACKGROUND: Hydatid disease is caused by the larval form of Echinococcus granulosus. The reported occurrence of bony hydatidosis is 0.5–3% of all the cases and 50% of them affect the spine. Nevertheless, lumbar vertebral involvement is extremely rare. The most common occurrence is the dorsal level. CASE REPORT: We present the case of a 32-year-old-military dog handler, who presented in 2018 to the urology department with an abdominal retroperitoneal mass. The MRI showed multilocular cystic lesions. The patient underwent surgery, and all of the cysts were removed. The anatomopathological evaluation concluded to hydatic cysts. He was briefly relieved from his symptoms. He was addressed to our department in 2020 suffering from lumbar-radicular pain and functional impotence of both lower limbs. MRI was performed showing multiple big cysts with inhomogeneous contents. CT scan showed destruction of the l5 vertebra. The patient underwent surgery. Initially, we performed through a posterior approach, an L4 to S1 laminectomy, posterior stabilization, and then total L5 corpectomy, anterior l4-s1 fusion through a xipho-pubic laparotomy after 2 months. Antihelminthic therapy was administrated. The patient’s symptoms completely disappeared. No signs of reoccurrence were noted at the 2-year follow-up. CONCLUSION: The primary extrahepatic cystic echinococcosis of bone is an extremely rare disease. Diagnosis can be long and difficult. It can lead to serious complications and should be highly considered in case of a cystic vertebral lesion in an endemic region. Spinal involvement is extremely rare but potentially curable with surgery and anthelmintic drug therapy.