Adnane Lachkar

Osteochondritis dissecans (OCD) of the femoral condyles is a subchondral bone necrosis, resulting in osteochondral fragmentation that causes joint dysfunction. Mosaic grafting consists of harvesting osteochondral grafts from a donor site and transferring them to the osteochondral defect. The objective of our study was to evaluate the results of mosaicplasty as a treatment for osteochondritis dissecans of the knee. This is a retrospective study of 04 cases of osteochondritis dissecans of the knee in the department of traumatology and orthopedics at the University Hospital Oujda, Morocco. The average preoperative IKDC functional score was 43. The lesions were classified according to Cahill's classification in zone 2 and 3, and according to Harding's classification in zone B and C. According to Bedeouelle's classification, the evolutionary stage was divided into one stage IIb case, two stages III, and one stage IV.MRI revealed two stage II cases and one case for each of the stages IV and V according to Hefti's classification. Our surgical treatment consisted of osteochondral reconstruction of the injured area by mosaicplasty. A first arthroscopic step allows us to evaluate the size and depth of the cartilage defect. The 4 patients had an OCD grade 4 ICRS. All our mosaicplasties were performed open after a medial arthrotomy. Progressive rehabilitation was started the next day, and weight-bearing was not allowed until the sixth week. The IKDC score was 84.5. The arthroscopic "second look" showed the integration of the grafts with the edges of the healthy hyaline cartilage, creating a "golf ball" appearance. The mosaic graft is a validated cartilage restoration technique [14]. Garretson et al [15] demonstrated that the optimal and least constrained site was the margins of the superomedial trochlea. Hangody et al [18] reported in a heterogeneous series of more than 1,000 mosaic grafts: 3% morbidity, four infections and 36 hemarthroses. Gudas et al [22] compared 29 mosaic grafts and 29 microfractures for lesions with an average size of 2.7 cm2 , and found a remarkable advantage of the mosaic graft in this indication. Mosaic grafting has the advantage of being less expensive than reconstructive techniques, performed in a single surgical step, and of offering immediate restoration of the cartilage surface.

Inveterate elbow dislocations remain common in developing countries. We report the case of a 17-year-old child who consulted us after six months of trauma to the left elbow. Clinical examination revealed a deformed elbow, locked in extension with a mobility sector of 5°. The Mayo Clinic Elbow performance score was sixty-six; the downstream vasculo-nervous examination was normal. The face and profile X-ray of the elbow showed a pure posterolateral elbow dislocation. We used the posterior medial para-tricipital and lateral approach, a first stage of arthrolysis was performed. A complete reduction was achieved by progressive and non-traumatic gentle maneuvers. Intraoperative elbow flexion was less than 80°, indicating a retraction of the triceps muscle, so a Z-lengthening plasty was necessary. This reduction was then fixed with two olecranon-humeral K-wires. At the third week, the plaster cast and K-wires were removed. The patient was subsequently referred to a physical therapist. After a ten-month follow-up, an undistorted and functional elbow with a gain of twenty-one points according to the Mayo Clinic score was obtained. Surgical reduction of a neglected elbow dislocation with triceps lengthening plasty, followed by a codified physical therapy program, results in a remarkable restoration of elbow function and stability.

Surgical treatment of distal tibial fractures is challenging because of the limited soft tissue coverage and poor vascularity. Managing these orthopedic conditions in pregnant patient is a great challenge for the safety of both mother and fetus. Intra-operative fluoroscopy can be used just when appropriate. Minimally Invasive Plate Osteosynthesis (MIPO) technique is a method of fixation that reduces surgical trauma without exposure of fractured zone. By using an identical plate to the first one already placed percutaneously, plate on plate technique reduces radiation exposure, operating time, amount of surgical trauma and cost of treatment. The holes of the second plate are used to guide the mini skin incisions for accurate placement of screws. Here we present a case of distal tibial fracture at the first gestation trimester treated with MIPO using a plate on plate technique.