Complex dorsal metacarpophalangeal joint dislocation associated with proximal metacarpal fracture: case report and review of the literature

INTRODUCTION

Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are uncommon injuries that mainly affect the index finger and are typically caused by a fall on an outstretched hand. It is exceptional for complex MCPJ dislocation to coexist with a distal fracture of the corresponding metacarpal bone.

PRESENTATION OF THE CASE

The authors report a case of a 23-year-old man presented to the emergency, with a complex dorsal metacarpophalangeal joint dislocation of the index associated with a distal metacarpal fracture confirmed by imaging. The patient had an open reduction and internal fixation of the proximal metacarpal fracture. The results were satisfying.

DISCUSSION

Dorsal MCP joint dislocations are rare, primarily affecting the index and little fingers, and are typically caused by a fall on an outstretched hand. Complex dislocations, characterized by irreducibility, involve structures forming a "noose" around the metacarpal head. Fractures associated with these dislocations are uncommon. Early diagnosis is crucial for better long-term functional outcomes. Radiographic imaging, including three different views, is necessary for accurate diagnosis. Surgery is usually required, with different approaches depending on the case. Arthroscopic techniques can be used when reduction is challenging. Timely surgical intervention yields the best results. Stiffness, osteoarthritis, osteonecrosis, and growth arrest in pediatric cases are the main complications.

CONCLUSION

Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are rare. Open reduction is typically necessary for optimal outcomes. Complications such as stiffness, osteoarthritis can arise, emphasizing the importance of accurate diagnosis and appropriate management.

Gluteus maximus abscess revealing a tuberculous arthritis: A case report and review of the literature

Although tuberculosis is a widespread disease in Morocco, musculoskeletal form is relatively rare and even rarer when affects the sacroiliac joint. Tuberculous sacroiliitis remains a challenge for orthopedists owing to its insidious onset and non-specific clinical presentation. Herein, we report the case of a 23-year-old male with a growing mass in his left gluteal area, diagnosed with tuberculous sacroiliitis, based on bacteriological and histological findings. The aim of our work is to draw attention to the importance of continued awareness for early detection and adequate treatment of this very rare entity.

Challenging Management of Large Aggressive Fibromatosis of the Anterior Abdominal Wall: A Case Report

Aggressive fibromatosis is a rare and benign tumor of soft tissues, locally invasive but never metastasizes. This proliferation arises in musculoaponeurotic structures. It is more common in young fertile women due to hormonal influences. Radical resection with free margins is the key to an effective outcome. We present here the case of a 47-year-old woman, without medical history, who was referred to our hospital for a painful swelling of the left iliac fossa, diagnosed with aggressive fibromatosis of the anterior abdominal wall based on radiological and histological findings. She underwent an excision of the mass with free margins followed by reconstruction of the musculo-fascial defect. After a follow-up of 12 months, there was no evidence of recurrence. Management of aggressive fibromatosis remains a challenge for surgeons. Complete excision of the tumor followed by reconstruction of abdominal wall defect is the first choice of treatment.

Unusual presentation of lateral sural cutaneous nerve schwannoma: An exceptional case report

Introduction

Schwannoma is the most common benign nerve sheath tumor. Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic.

Case presentation

We report the case of a misleading clinical presentation of lateral sural cutaneous nerve schwannoma.

Discussion

To the best of our knowledge, no case has been reported about the location of schwannoma in the lateral sural cutaneous nerve. MRI and anatomopathologic assessment, after microscopic enucleation, are required to confirm diagnosis.

Conclusion

Care must be taken to not miss a schwannoma of lateral sural cutaneous nerve by meticulous clinical examination and appropriate imaging using MRI in unexplained L5 sciatica.

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Schwannoma is the most common benign nerve sheath tumor

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Peripheral nerves of the lower extremity are rarely involved and usually asymptomatic

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MRI shows isointense or decreased signal relative to the skeletal muscle on T1-weighted images and heterogeneously increased signal intensity on T2-weighted images

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Microscopic enucleation is treatment of choice

A report of two challenging cases of bone infection: Mycobacterium tuberculosis. How to manage?

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.

Complex metacarpophalangeal joint dislocation of the litter finger: A sesamoid bone seen within joint. What does it mean?

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.

Lipomatosis of interdigital nerves: Unusual localization

Lipomatosis of the nerve (LN) is a rare benign tumor that is characterized by proliferating fibrous fatty tissue surrounding and infiltrating the peripheral nerves. While there are numerous case reports of LN affecting the median nerve and its branches, there are few reports, to the authors' knowledge, of their occurrence in the foot and ankle. A rare case of LN involving the second and third interdigital nerve in a 41-year-old man, which was successfully treated with surgical excision, is reported.

[Sclerotherapy for recurrent glomus tumors]

We report the cases of two women aged 28 and 34 years who presented recurrent glomus tumors of the hand after surgery for marginal resection of the tumor mass. The pathological study of the surgical specimen confirmed the diagnosis of recurrent glomus tumor. Due to the vascular origin of this tumor, sclerotherapy was delivered. The functional outcomes were good with dramatic pain relief within a few days. At 3-year mean follow-up, the cosmetic and functional results were very satisfactory.

[Bilateral capitulum humeri fracture, a case report and review of the literature]

Fracture of the capitellum is an intra-articular fracture of the distal humeral metaphysis and usually occurs in the frontal plane. It is a rare fracture and even more unusual when bilateral. The authors report a case of bilateral isolated fracture of the capitellum (Hahn-Steinthal type I) in a woman aged 28 years, treated surgically. A posterolateral approach was used for both elbows. Internal fixation was performed using two Herbert screws in the right elbow, and AO screws in the left elbow. Both elbows were immobilised for 3 weeks before commencing an intensive mobilization program guided by a physiotherapist. The end result was very satisfactory: both elbows were pain-free, with a complete range of movement on the right and a 10 degrees loss of extension on the left. Radiologically, consolidation was complete and there were no signs of avascular necrosis. Based on a review of the literature, the authors favour the use of Herbert screws in the treatment of capitellar fractures. They give good inter-fragmentary compression and reduce the risk of damaging the articular surface due to their subarticular position.

Tuberculous sacroiliitis. Four cases

Tuberculous sacroiliitis with no local abscesses or tuberculosis at other sites occurred in four patients, three men and one woman with a mean age of 42 years. Slow progression characterized this uncommon variant of joint tuberculosis. Two patients reported contact with family members known to have tuberculosis. Mean time from symptom onset to presentation was 14 months. Surgical biopsy showed epithelioid and giant-cell granulomas with caseous necrosis; culturing on Lowenstein-Jensen medium recovered the tubercle bacillus. Treatment was with antitubercular drugs, and protection from weight bearing for 4 weeks. These four cases illustrate the slowly progressive course of the clinical and radiological manifestations and underline the diagnostic difficulties met in the early stages of tuberculous sacroiliitis without tuberculosis at other sites. Antitubercular treatment can restore joint function provided the diagnosis is made before radiological destruction occurs.

Tuberculose du poignet

PURPOSE OF THE STUDY

We present our experience with a rare localization of tuberculosis, the wrist, focusing on symptoms and outcome after treatment.

MATERIAL AND METHODS

Our series included eleven patients, eight men and three women, mean age 42 Years, who presented tuberculosis of the wrist. Tuberculosis was known in four patients who were being treated and a context of tuberculosis was recognized in three others. One patient on long-term corticosteroid therapy was immunodepressed. Mean time from symptom onset to consultation was fifteen months indicating a slow and progressive disease process. An inflammatory syndrome was noted in nine patients. Based on the standard x-rays, the David-Chausse classification was: stage I n=1; stage II n=1; stage III n=3; stage IV n=4. The AP view of the wrist was normal in two patients. Diagnosis of tuberculosis was confirmed on the surgical biopsy specimen which revealed epithelio-gigantocellulary granuloma with caseous necrosis. In only five patients Koch bacilli developed in culture on Lowenstein-Jensen. Patients were given anti-tuberculous antibiotics and the wrist was immobilized in a plaster splint.

RESULTS

Mean follow-up was two years. The disease course was blunted by the antituberculosis treatment. Surgical drainage was only required to clear abscesses. Wrist stiffness was frequent and had a significant functional impact.

DISCUSSION

These eleven cases of a rare localization of tuberculosis illustrate the slow progressive course of clinical symptoms and radiological signs of tuberculosis, emphasizing the difficulties encountered in establishing early diagnosis of such isolated non-abscessed localizations. Anti-tuberculous treatment is effective but the functional outcome depends on early diagnosis before the development of radiological evidence of joint destruction.