Introduction: Bilateral ankle fractures are rare injuries, particularly as closed supratubercular bimalleolar fractures. These unstable patterns involve a fibular fracture above the syndesmosis with medial malleolar injury and require precise anatomical reduction to restore ankle stability. Bilateral symmetrical involvement is exceptionally uncommon and may result from synchronized rotational forces applied to both ankles. Case Presentation: A 35-year-old male with no prior medical history sustained bilateral ankle trauma after a low-energy fall. Examination showed bilateral swelling, deformity, and inability to bear weight, with intact skin and preserved distal neurovascular status. Radiographs revealed bilateral supratubercular lateral malleolar fractures associated with oblique medial malleolar fractures, confirming bilateral closed bimalleolar ankle fractures. The patient underwent single-stage bilateral open reduction and internal fixation using plate-and-screw constructs for the fibulae and cancellous screws for the medial malleoli, along with bilateral transsyndesmotic fixation. Postoperatively, immobilization was followed by progressive rehabilitation. Radiographic union was achieved at six weeks, and full, pain-free functional recovery was observed at three months. Discussion: Bilateral ankle fractures are exceptional and may occur when similar rotational forces act simultaneously on both ankles. Supratubercular fibular fractures are often associated with syndesmotic disruption, making stabilization essential to restore ankle congruence and prevent long-term complications. Rigid internal fixation combined with syndesmotic stabilization allows early rehabilitation and favorable outcomes. Conclusion: Bilateral closed supratubercular bimalleolar ankle fractures are an extremely rare injury pattern that can result from simultaneous rotational forces. Early diagnosis, anatomical reduction, stable fixation, and structured rehabilitation are key to achieving excellent functional outcomes.

High-voltage electrical injuries are rare but devastating events, frequently associated with deep tissue destruction, vascular thrombosis, and severe systemic complications. Traumatic electro-amputation of a limb at the scene of the accident is exceptional and reflects the extreme severity of the injury. We report the case of a 24-year-old man with no prior medical history who sustained a high-voltage electrical injury resulting in spontaneous mid-leg amputation at the accident site. Despite early surgical management and intensive care, the patient developed severe rhabdomyolysis complicated by multiorgan failure, leading to death within 48 hours. This case highlights the pathophysiology, management challenges, and poor prognosis associated with high-voltage electrical trauma complicated by rhabdomyolysis.

Proximal tibiofibular joint (PTFJ) dislocation is an uncommon injury that is frequently overlooked, particularly when associated with more evident lesions of the lower limb. We report a rare case of PTFJ dislocation associated with an ipsilateral lateral malleolar fracture following a road traffic accident in a 35-year-old female patient. Clinically, the patient presented with knee and ankle pain, inability to bear weight, and subtle prominence of the fibular head. Radiographic assessment revealed an anterolateral dislocation of the proximal tibiofibular joint combined with a supratubercular fracture of the lateral malleolus. Surgical management was performed, consisting of open reduction and internal fixation of the lateral malleolus using a plate and screws, followed by anatomical reduction and stabilization of the PTFJ with a transarticular screw. Postoperative evolution was uneventful, and progressive rehabilitation was initiated after six weeks of immobilization. At three months follow-up, the patient regained full weight bearing with satisfactory knee and ankle range of motion and no evidence of instability or neurological deficit. This case highlights the importance of a systematic clinical and radiological evaluation of the entire tibiofibular axis in patients presenting with ankle trauma. Early diagnosis and appropriate surgical management are essential to prevent chronic instability and ensure favorable functional outcomes.

Acetabular fractures account for 3% of all fractures and typically result from high-energy trauma. Their management remains challenging owing to the complex three-dimensional anatomy of the acetabulum and the frequent association with other injuries. Conservative treatment entails prolonged hospitalisation and decubitus-related complications, whereas open surgical reduction is technically demanding and carries risks including heterotopic ossification, nerve injury and infection. During the COVID-19 pandemic, the need to shorten hospital stays and limit bed occupancy prompted the development of a novel percutaneous technique, termed Rahmi osteotaxis, for the treatment of displaced acetabular fractures. Methods: We report a prospective series of twenty patients (fourteen men and six women; mean age 57 years) operated on for acetabular fractures in the Orthopaedic-Traumatology Department of Ibn Rochd University Hospital, Casablanca, over a five-year period. Fractures were classified according to Judet and Letournel, with six simple transverse and fourteen complex fractures, predominantly both-column patterns. The technique employs a Hoffmann-type external fixator with six pins placed percutaneously in the supra-acetabular, femoral neck and subtrochanteric regions, producing vector traction that achieves instantaneous and stable reduction under fluoroscopic control. Reduction quality was assessed using Matta’s criteria and the Duquennoy and Senegas classification; functional outcome was evaluated with the Postel and Merle d’Aubigné score. Results: Mean operative time was 20 minutes with minimal blood loss. Reduction was satisfactory in sixteen cases and unsatisfactory in four. Vertical congruence was perfect in 60% and good in 40% of cases. All patients were discharged on the second postoperative day. The fixator was removed at six weeks, with full weight-bearing allowed from the third month. At a mean follow-up of four years, functional results were good in 80% of cases. One case of secondary coxarthrosis required total hip arthroplasty; no pin-site infection, deep vein thrombosis or secondary displacement occurred. Conclusion: Rahmi osteotaxis is a safe, reproducible alternative to conservative treatment of displaced acetabular fractures, particularly valuable when major surgery is contraindicated or in damage-control settings.

Focal cartilage lesions of the knee are rare and can be primary (osteochondritis dissecans) or secondary (traumatic) [1, 2]. Their diagnosis relies on magnetic resonance imaging (MRI) and arthroscopy, which help determine the extent of the lesions, their locations, and whether they are stable or unstable [3]. Surgical treatment is reserved for painful lesions located in weight-bearing areas. Surgical therapeutic modalities can either be palliative, such as Pridie drilling and micro fractures aimed at promoting the formation of fibrocartilaginous scar tissue which has biomechanical properties inferior to those of hyaline cartilage, or reparative treatments like mosaicplasty. Mosaicplasty involves harvesting osteochondral grafts from a donor site and implanting them into osteochondral defect areas, resulting in hyaline cartilage tissue of superior quality [2, 4].

This case report describes a 52-year-old chronic smoker with Buerger’s disease (thromboangiitis obliterans) who presented with gangrene of the index finger. Buerger’s disease, a nonatherosclerotic inflammatory condition affecting small- and medium-sized arteries, is strongly associated with tobacco use. The patient, who had a history of thumb amputation due to the same condition, underwent a Chase amputation of the index finger. This procedure involves amputation at the base of the second metacarpal, allowing for the preservation of hand function, particularly the pollicidigital grip, while maintaining aesthetic appearance. The discussion highlights the functional importance of the index finger and the role of amputation in cases where significant tissue damage occurs. Buerger’s disease, primarily affecting young male smokers, lacks definitive treatment other than absolute smoking cessation. Surgical interventions like bypass are often ineffective due to the disease’s progression and distal arterial involvement. In conclusion, Chase amputation proved to be a functionally effective intervention for this patient, restoring hand grip and addressing the complications of Buerger’s disease. The case underscores the critical need for smoking cessation to prevent disease progression and the importance of tailored surgical approaches in managing severe digital ischemia.

Nail melanoma is rare and has a poor prognosis. It represents between 0.18 and 2.8% of all cutaneous melanomas. Amputation is usually performed for invasive nail melanoma, but not all invasive melanomas invade or attach to the distal phalanx. Our aim was to report a case of 56-year-old patient with history of a manipulated melanonychial band of the right big toe since 5 years presenting a nail melanoma with bone infiltration .Our patient illustrates the consequences of the late diagnosis of nail melanoma which led to a deep progression and the invasion of bone by the malignant melanocytes.

Synovial sarcoma (SS) is a malignant soft tissue tumor characterized by a high recurrence rate and distant metastases. This sarcoma typically arises near the knee and in the proximal region of the upper limb. The prognosis for SS is poor. Conservative surgical treatment is the preferred approach, but in advanced cases, amputation may sometimes be the only salvage solution]. Only a few cases of malignant tumors with vasculonervous infiltration of the scapular girdle have been documented in the literature. Interscapulo-thoracic disarticulation serves as a salvage treatment for sarcomas affecting the scapular girdle. This radical surgical amputation, which removes the entire upper limb, is indicated primarily in cases of neurovascular infiltration, failure of conservative treatment, and complications such as severe lymphedema and hemorrhage. Here, we present the case who underwent interscapulo-thoracic disarticulation for a locally advanced synovial sarcoma of the right arm

INTRODUCTION L’enclouage centromédullaire antérograde à foyer fermé est le traitement de référence des fractures diaphysaires du fémur. Néanmoins, la complexité du foyer de fracture rend cette procédure difficile et représente pour les chirurgiens un véritable défi, tant sur le plan technique que sur le suivi post-opératoire. PATIENTS ET METHODES Il s'agit d'une étude rétrospective portant sur 40 cas de fractures complexes de la diaphyse fémorale. Ces patients, âgés de 16 ans ou plus, ont été traités par enclouage centromédullaire antérograde pendant une période de 5 ans (2016-2020), au service de chirurgie orthopédique et traumatologie (P 32) du centre hospitalier Ibn Rochd de Casablanca. Le suivi moyen de notre étude était de 15,9 mois. RESULTATS Sur les 321 patients traités pour des fractures de la diaphyse fémorale, 62 présentaient une fracture complexe, représentant une prévalence globale de 19,3 %. Parmi eux, 40 patients répondaient aux critères d'inclusion. L'âge moyen était de 40 ans, [16 à 64]. Il y avait 72,5 % d'hommes. La cause principale des fractures était l'accident de la voie publique pour 37 patients (92,5 %). Quatre patients (10 %) avaient des fractures ouvertes. 34 patients (85 %) ont bénéficié d’un enclouage à foyer fermé, alors que six étaient à foyer ouvert, dont trois étaient associés à un cerclage. Le taux global de complications était de 20 % (8 patients), incluant deux cas d’embolie graisseuse, un cas (2,5 %) d’infection du site opératoire, un cas de raccourcissement, un cas de rotation, deux cas (5 %) de retard de consolidation dans le groupe d’enclouage à foyer fermé et deux cas (5 %) de pseudarthrose aseptique dans le groupe d’enclouage à foyer ouvert. Le taux global de consolidation était de 95 % (38 patients) à 12 mois, avec une durée moyenne de consolidation de 6 mois. DISCUSSIONS ET CONCLUSION La prévalence des fractures complexes de la diaphyse fémorale est de 19 % à 52 %; elles touchent essentiellement le sujet jeune masculin suite à un traumatisme routier. L'enclouage centromédullaire verrouillé à foyer fermé reste le gold standard dans la prise en charge de ce type de fracture, mais leur gestion reste difficile, avec un taux de retard de consolidation et de pseudarthrose allant jusqu'à 30 %. Elles représentent un véritable défi pour la chirurgie dite à foyer fermé, notamment en cas de difficulté de réduction (absence de réduction après 15 min de tentatives), de fracture bifocale, et de persistance d’un écart interfragmentaire important ou d’inversion du 3ème fragment. Une réduction à foyer ouvert serait préférable chez certains auteurs, bien que cette approche puisse influencer la consolidation osseuse et prédisposer à l’infection et à la pseudarthrose. Nous invitons les chirurgiens à envisager des techniques moins invasives afin de préserver les avantages du traitement à foyer fermé.

Talar fracture are the second common after calcaneum in tarsal bones. High-energy trauma (road traffic accident and fall from height) involving forced dorsiflexion of the ankle cause fracture. More frequently, talus fracture involves neck and body is the least. The combination of talar body fracture and ankle dislocation, along with ipsilateral medial malleolar fracture, is exceptionally rare. Few cases have been reported till now that medial side talar body fractures, is typical of supination trauma (compression or shear type), whereas a lateral side fracture is due to pronation or pronationexternal rotation trauma (compression fracture). Talar body fractures have the highest incidence of posttraumatic osteoarthritis among talus fractures. We report the case of 54-year-old male who sustained a fall from 4 meters. Radiological assessment revealed a Type 2 talar dome fracture and a C1 tibial plafond fracture. The patient underwent surgical fixation with Herbert and cancellous screws, followed by immobilization for 45 days

We report the unprecedented case of a patient presenting with a trifocal femoral fracture associated with a central hip dislocation resulting from high-energy trauma. This combination of injuries, never described before in the literature, highlights the complexity of combined trauma. Management required surgical reduction and internal fixation, followed by progressive rehabilitation. This case underscores the diagnostic and therapeutic challenges associated with these rare injuries and emphasizes the importance of a multidisciplinary approach to optimize functional outcomes.

Introduction: Neurofibromas are rare benign tumors of peripheral nerve sheaths, and hand involvement is particularly uncommon. This case report presents a large neurofibroma located in the thenar region, a critical area for thumb opposition and hand dexterity, posing unique surgical challenges. Presentation of case: A 23-year-old female presented with a 3-year history of a progressively enlarging mass in the thenar region of the right hand, accompanied by nocturnal pain but no neurological deficits. MRI revealed a wellcircumscribed, multilobulated tumor measuring 54 x 55 x 33.4 mm. Surgical excision was successfully performed while preserving the median nerve. Postoperative recovery was assessed using the QuickDASH questionnaire, yielding a score of 6, indicative of excellent functional outcomes. Histopathology confirmed a benign neurofibroma. Clinical discussion: The large size and rare location of this tumor, combined with the absence of neurofibromatosis type 1, make this case noteworthy. Early diagnosis and meticulous surgical planning enabled complete excision while preserving critical structures, resulting in full functional recovery with no recurrence after 18 months. Conclusion: This case underscores the importance of individualized surgical strategies for managing neurofibromas in functionally critical areas. While excellent long-term outcomes were achieved in this instance, further studies are needed to validate these findings and refine management approaches.

The floating elbow is a rare lesion, characterized by the presence of a fracture of the humerus and one or both bones of the homolateral forearm. Double disturbances of the upper suspensory shoulder complex, commonly referred to as “floating shoulder” injuries, are ipsilateral fractures of the clavicle and scapula with loss of bone attachment of the glenoid. The combination of a floating elbow and floating shoulder is extremely rare, added an ipsilateral dislocation of the glenohumeral remains exceptional. No case has been reported in the literature of such a lesional association. This observation makes it possible to describe an extremely rare lesion, by proposing the therapeutic attitude and the prognosis.

Introduction and importance: Hibernoma is a rare benign adipose tumor that arises from brown fat. Often misdiagnosed as liposarcoma, hibernomas require biopsy and histopathological examination for accurate diagnosis. This case report presents an unusual instance of hibernoma located in the posterior thigh of an elderly patient, emphasizing the diagnostic challenges and surgical management involved. Case presentation: We report the case of Mrs. F.D., a 70-year-old woman with a history of ovarian cyst surgery 17 years prior, who presented with a mass in the posterior left thigh. The mass had been developing over two years and was hard, painless, and measured 7 x 12 cm. Initial imaging suggested liposarcoma; however, an MRI revealed a 9 x 19 cm mass with heterogeneous tissue characteristics. A surgical biopsy confirmed the diagnosis of hibernoma. The tumor was excised completely, and histological examination showed typical features of hibernoma. Clinical discussion: Hibernomas, although rare, should be considered in the differential diagnosis of soft tissue masses. Imaging techniques such as MRI are essential, but definitive diagnosis relies on histopathology. Surgical excision is the treatment of choice, requiring meticulous technique to manage the hypervascular nature of the tumor. Conclusion: This case underscores the importance of considering hibernoma in differential diagnoses and highlights the role of biopsy for accurate diagnosis. Complete surgical excision is crucial to prevent recurrence. Further research is needed to better understand the pathogenesis and optimal management of hibernomas.

Introduction and importance: Posterolateral knee dislocations are rare, complex injuries predominantly resulting from high-energy trauma. They present significant diagnostic and therapeutic challenges, crucial for maintaining long-term knee function and stability. Case presentation: We report the case of Mr. Y.G., a 34-year-old male who suffered a left knee posterolateral dislocation due to a motorcycle accident. Clinical examination and imaging revealed a valgus deformity, swelling, ecchymosis, and a persistent medial joint line groove. The injury was classified based on NEYRET et al. criteria and 2008 SOFCOT standards. Surgical intervention involved repairing medial structures and applying a femoro-tibial external fixator. Radiographic and MRI findings confirmed a complete capsuloligamentous rupture and chondral injury of the lateral condyle. Clinical discussion: This case exemplifies the critical need for rapid radiological evaluation and tailored surgical interventions in managing posterolateral knee dislocations. It also demonstrates the effectiveness of using established classification systems for treatment planning and prognostic prediction. Conclusion: Timely and suitable management is essential for successfully treating posterolateral knee dislocations. Utilizing recognized classification systems plays a key role in guiding management decisions and improving patient outcomes, ensuring optimal recovery and knee functionality.

Introduction and importance: Osteoid osteoma is a benign primary bone tumor with a predilection for the long bones and vertebrae, presenting a unique challenge when occurring in rare locations such as the talus, accounting for 5 to 8 % of cases. Early imaging struggles to detect its nidus, leading to diagnostic delays, especially when atypical symptoms and previous trauma complicate clinical presentations. This case report illustrates the diagnostic challenges and emphasizes the importance of targeted computed tomography (CT) guided by scintigraphy in diagnosing osteoid osteoma of the talus. Case presentation: A 23-year-old male presented with chronic left ankle pain spanning three years, with a history of previous trauma. Initial evaluations including standard radiology and magnetic resonance imaging (MRI) suggested algodystrophy of the talus and tenosynovitis, but failed to identify the osteoma. Persistent pain led to further investigation with bone scintigraphy, revealing hyperfixation indicative of partial algodystrophy. Targeted CT scans focused on the scintigraphy-identified area ultimately revealed an osteoid osteoma's nidus, enabling successful surgical intervention and symptomatic relief. Discussion: The diagnosis of osteoid osteoma in the talus is frequently delayed due to its atypical presentation and rare occurrence. Traditional imaging techniques may overlook the tumor's nidus, underscoring the necessity for targeted diagnostic approaches. This case demonstrates the value of integrating scintigraphy with targeted CT to enhance early diagnosis and treatment planning, contrasting with the limited diagnostic yield of MRI and underscoring CT's superiority for nidus detection. Conclusion: Osteoid osteoma of the talus poses significant diagnostic challenges. This case report highlights the utility of scintigraphy-guided targeted CT in identifying the nidus and facilitating prompt surgical management, advocating for a multidisciplinary approach to atypical ankle pain, especially in patients with a history of trauma.

INTRODUCTION:Peri-implant fractures (PIFs) are uncommon yet critical complications following orthopedic surgery. These complications can significantly impact a patient's psychological well-being and overall quality of life. AIM:This study aimed to investigate the psychological effects of PIFs. METHODS:This was a cross-sectional study that involved 136 patients who underwent surgery for PIFs between 2018 and 2022. We utilized various validated scales and questionnaires such as Hospital Anxiety and Depression Scale (HADS), Perceived Stress Scale (PSS), Impact of Event Scale Revised (IES-R), 36-Item Short Form Survey (SF-36), and Brief COPE Inventory (BCI) to assess their psychological state. RESULT:The results revealed that patients with PIFs experienced higher levels of anxiety, depression, stress, and post-traumatic stress compared to the general population. Additionally, they reported lower physical and mental health. Factors such as the number of surgeries, treatment delay, post-operative pain levels, and complications significantly influenced their psychological outcomes. Notably, acceptance, positive reframing, and seeking emotional support were the most common coping mechanisms employed by these patients. Conversely, denial, substance use, and self blame were the least employed strategies. CONCLUSION:This study suggests that psychological interventions could significantly benefit patients with PIFs, potentially reducing their distress and improving their quality of life.

INTRODUCTION:The increase in hip arthroplasties predicts a rise in periprosthetic fractures in Morocco, posing challenges for orthopedic surgeons. Therapeutic strategies vary considerably, highlighting the absence of a universally accepted treatment protocol. AIM:To analyze the management of per-prosthetic hip fractures, while addressing the challenges associated with them. METHODS:This was a retrospective study, conducted in the trauma-orthopedics department between December 2015 and November 2022. Nineteen patients who presented to the hospital with fractures around a hip prosthesis were included. RESULT:Nineteen periprosthetic fractures were observed. The majority of patients (68%) were women, with an average age of 68. The Vancouver classification showed that 52.6% of the fractures were type B1, and 21.1% type C, while the other fracture types were distributed differently. These fractures were mainly associated with diagnoses such as femoral neck fracture (63.2%) and coxarthrosis (31.6%). We observed variations in treatment recommendations and results between the different series analyzed. We noted discrepancies with certain series concerning fracture types and therapeutic choices. However, in our series, we achieved satisfactory results, with successful consolidation and the absence of complications in all patients. CONCLUSION:These results underline the importance of an individualized approach to fracture management, taking into account the specificities of each case.

INTRODUCTION AND IMPORTANCE:Conditions mimicking tumors within the knee, such as arborescent lipoma and synovial chondromatosis, are generally benign yet closely linked to inflammatory or degenerative joint diseases. While each condition is commonly documented individually with osteoarthritis, their concurrent presentation within the same knee is extremely rare. This case report adheres to the SCARE 2023 guidelines (Sohrabi et al., 2023) and aims to shed light on the diagnostic and therapeutic challenges posed by the rare coexistence of these conditions, presenting unique management challenges. CASE PRESENTATION:We detail the case of a 67-year-old woman who has been suffering from progressively worsening bilateral osteoarthritis for over five years, with significant impairment in her right knee. Symptoms included persistent pain unresponsive to standard treatments, reduced mobility, and recurrent swelling. A comprehensive diagnostic evaluation through clinical examination, radiography, and magnetic resonance imaging (MRI) suggested tricompartmental osteoarthritis complicated by suspected arborescent lipoma. Surgical exploration not only confirmed the presence of arborescent lipoma but also revealed synovial chondromatosis. Both conditions were validated during total knee arthroplasty via histopathological examination, and the patient demonstrated significant functional recovery 18 months postoperatively. CLINICAL DISCUSSION:The simultaneous occurrence of arborescent lipoma and synovial chondromatosis within an osteoarthritic knee emphasizes the complex nature of diagnosing and managing advanced joint pathologies. This case highlights the critical need for thorough diagnostic processes to differentiate between multiple potential diagnoses and the vital role of surgical intervention in managing such intricate conditions effectively. CONCLUSION:The rare coexistence of arborescent lipoma and synovial chondromatosis in an osteoarthritic knee underlines the complexities of diagnosing and managing joint diseases. It accentuates the necessity of an exhaustive diagnostic approach and demonstrates the efficacy of surgical management in achieving favorable outcomes. This case supports the need for maintaining a broad differential diagnosis and underscores the value of interdisciplinary collaboration in managing complex joint pathologies.