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.

BACKGROUND: Total knee arthroplasty (TKA) is effective in treating end-stage osteoarthritis. Nevertheless, 20% of patients remain unsatisfied with the outcome at 1 year. AIM: The aim of our study was to identify the radiological parameters influencing the functional result and patient’s quality of life (QOL). METHODS: We conducted a retrospective observational study of patients who underwent primary TKA between 2015 and 2019. Standard radiographs were used to assess alignment parameters, patellar height, and implant size. Knee function was assessed using the Knee Society Score (KSS) and the QOL through the “Sfax modified Western Ontario and McMaster Universities osteoarthritis index (WOMAC).” RESULTS: One hundred and twenty cases were analyzed. The results in terms of alignment showed on average: an overall alignment of 2.41° varus, a coronal orientation of the femoral component of 5.49° of valgus, a coronal orientation of the tibial component of 2.16° of varus, a flexion of the femoral component of 0.7°, and a tibial slope of 2.6° with posterior orientation. We identified 19 cases of Patella baja (PB) and seven cases of pseudo PB. We identified 18 cases of oversizing of the femoral implant and six cases of undersizing. The tibial implant was oversized in ten cases and undersized in three cases. Global alignment of the limb and coronal alignment of the tibial component significantly influenced KSS and WOMAC scores. There was also a significant association between patellar height, knee function, and QOL. Femoral component size and overhang of the tibial component showed a significant influence only on WOMAC score. CONCLUSION: Standard radiography can be effective and reliable to evaluate TKAs. According to our results, we may suggest a checklist aiming to optimize knee function and patient’s QOL. It should include mechanical alignment of the limb, coronal alignment of tibial component, prevention of iatrogenic patellar tendon shortening, and precision in implant size choice.

The association of pulmonary tuberculosis and Behçet’s disease revealed by an aneurysm of the humeral artery is exceptional with a complicated management. We report a case in which the two conditions occurred concomitantly with the vascular complication, apart from any use of immunosuppressive therapy, something that has never been reported in the literature. We report an extremely rare case of a spontaneous rupture of an aneurysm of the humeral artery of a 29-year-old woman, with no history. The patient underwent axillo-humeral bypass. Investigations concluded the diagnosis of Behçet’s disease associated with pulmonary and lymph node tuberculosis. Anti-tuberculous chemotherapy followed by corticosteroids, immunosuppressants and colchicine have been administrated. Based on this observation, we insist on the necessity of searching the symptoms of Behçet’s disease in the presence of arterial involvement when having a young patient. Therapeutic management must include medical treatment to control inflammation and limit the risk of recurrence. Endovascular or surgical treatment is necessary if the arterial involvement is threatening. The association with tuberculosis complicates management and requires close monitoring.