POSTERS

GHADEER HIKMAT MAJEED SHAYA

AL KINDY TEATCHING HOSPITAL-IRAQ

A retrospective study of 8 cases of comminuted fracture of lower end of radius treated between 1998-2000 at al kindy teaching hospital.

- 7 cases were male, 1 case was female.

- Average age between 25-40 years.

- External fixator was put between the radius and the second metacarpal.

- Average duration of fixation was 2.5 months.

- Very good range of movement was obtained fol1owing removal of the fixator.

External fixator is an effective, wav of treating such factures , it provides a good way of achieving and maintaining reduction of such fracture.

RAMI AHMED AL-ANBARI

HEAD OF ORTHOPEDIC DEPT. AL KINDY TEACHING HOSP.- IRAQ

Segmental Tibial fractures are usually compound fractures and rarely presented as closed fractures. Four cases of closed segmental tibial fractures are treated by minimal internal fixation, fragmentary screws or neutralizing plate or by both with external fixator.

In these cases, the fracture sites were explored and very minimal detachment of the soft tissue and the periosteum . In two cases, immediate bone graft was applied, one for the upper tibial fracture and one for the lower fracture. Partial weight bearing started after 10 weeks . Union was gamed in 18-24 weeks. No case of non-union was reported. Pin track discharge occur In one case, but no deep infection (osteomyelitis) was reported.

S. SIDIBE* , FM DEITA* , SM. THIAM*, AK. MAIGA*, S. BACCARI**, L. TARHOUNI**, BAHRI H**.

HOPITAL DE KATI MALI.**INSTITUT D’ORTHOPÉDIE M. KASSAB .TUNIS.

The chronic osteomyelitis is still a very frequent affection in Mali. Its evolution which occurs often without suitable treatment explains the appearance of big sequesters and serious loss of shape it generates. The goal of this study is to specify some clinical, anatomo-

pathology and radiology aspects of this affection.

It was question of retrospective and prospective study to January 1990 at December 1997. Were concerned by this study all patients suffering of chronic osteomyelitis, received in Kati Hospital and followed up during 1 year at last. The use of these selection criterias allowed us to have 56 patients concerned. Distributions of these patients according signs, suffering bones, the sit on the femur and tibia and radiology sessions are reported.

TRABELSI M. - AMMARI T. - ZRIG M. -CHEHIMI A.-CHERIF M. -ESSAIS M. - M’BAREK M. -ESSADAM H. - BEN HASSINE H.

AZIZA OTHMANA HOSPITAL -TUNISIA

Sus epicondylian percutanous pining of humerus, is since 20 years, a current method of osteosynthesis when surgical treatment of humerus fractures is indicated , in our institution.

Authors reports their experience and indications in a current study of 300 cases of humeral fractures. Complications are rare:

Nu 3%

Angulation > 15° 0,5%

Infection 0,%

S. ROUKOZ – K. KHARRAT – F. DAGHER

HOTEL DIEU DE FRANCE LEBANON

Eight patients who sustained a fracture of the lateral scapular spine were treated operatively by a posterior subdeltoïd approach as described by Bradsky and his colleagues. There were 6 males and 2 females with a mean age of 45 years.

The cause of injury were 4 motor vehicle accident, 3 falls and 1 crush injury.

All the patients had a displacement superior to 1 cm of the lateral cortex or a tilt of more than 40°.

All patients were operated by the same surgeon using a subdeltoid approach without any muscular section. The bone was fixed with a four hole blade.

The post-operative follow-up consisted of a sling for one week followed by a passive physical therapy for two more weeks.

He mean follow-up is two years and a half and the outcome of these patients was excellent and three good results. One complication occurred as a fracture of the blade but with no compromise on the result.

We believe that this simplified approach described for posterior shoulder stabilization is suitable for the treatment of the lateral scapular spine fracture and give better results than orthopaedic treatment or surgery using a more aggressive approach.

GARGOURI A. – ZOUARI O.

KASSAB INSTITUTE TUNISIA

The authors report 2 cases of congenital pseudarthrosis of the leg (Recklinghausen illness) ho has been operated numerous before. They have been bone graft, intramedullar nail, with fibular bone graft, but we have never obtain the bone union.

With Ilizarov method the bone union is obtained in an average of 6 months.

Evidently, the first consequence is a shortness of the lower limb, which is corrected by lengthening of the leg.

GARGOURI A. – ZOUARI O.

KASSAB INSTITUTE TUNISIA

The authors report two cases of foot deformity. These deformities are very complex the etiology is congenital. The treatment by open surgical is impossible because the cutaneous cause and the vascular and nerve causes. The amputation is also a therapeutic possibility to have a fast functional adaptation.

We choose the correction of these deformities by the Ilizarov method. This method needs a long time to obtain the correction ho is progressive, this method is also a painly one, but it permit to correct the foot’s-deformity, and the children can walk a correct bear-and can have a normal footwear.

An open surgery can complete the therapeutic program (arthrodesis), the final result is satisfactory.

TAREK ABDALLA EL-GAMMAL, AMR EL-SAYED

DEPARTMENT OF ORTHOPEDICS, HAND AND RECONSTRUCTIVE MICROSURGERY UNIT ASSIUT UNIVERSITY SCHOOL OF MEDICINE -EGYPT

Vascularized fibular grafts have proved to be a reliable method in treatment of congenital pseudorthrosis of the tibia (CPT) with high success rate.

However, severe shortening cannot be corrected by this technique and requires a second stage lengthening procedure. Ilizarov method is another attractive option for treatment of CPT which allows correction of shortening and axial rnalalignment together with the non-union with comparable success rate especially in cystic and normotrophic types of CPT . However, in cases of dysplastic type of CPT with severe shortening, corticotomy may present a risk of delayed consolidation or recurrence of neurofibroma or fibrous dysplasia. In addition, the great length of the distraction gap (equal the amount of shortening plus the defect after excision of the pseudorthrosis site) may further prolong the healing time and extend the period of frame application. We present a new technique which allows simultaneous correction of shortening while treating the non-union in a single stage operation avoiding corticotomy in the diseased bone with shorter time of frame application and better patie! nt tolerability.

TRABELSI M. – AMMARI T. – CHERIF M. – M’BAREK M. – ESSADAM H. – BEN HASSINE H.- GHARBI Y.* – ESSAYED S.*

HOPITAL AZIZA OTHMANA *SERVICE DE CHIRURGIE PÉDIATRIQUE HOPITAL HABIB THAMEUR-TUNISIA

Slipped capital femoral epiphysis (SCFE) is the most common hip disorder in the adolescent age group. Its incidence ranges from 0,2 TG 10/100.000 depending on the study group population.

Standards orthopedics texts have commonly describe the slippage in coxa vara .We have recently two patients who developed the SCFE with a coxa-valga slip.

After review of the literature we found only 3 cases publishes; and we don’t found any etiological forms representing a predisposition of this kind of slippage.

TRABELSI M.- ZRIG M. –CHERIF M. – ESSAIS M. - M’BAREK M. – ESSADAM H. – BEN HASSINE H. - GHARBI Y.* – SAYED S. *

Hopital Aziza OTHMANA * Service chirurgie pédiatrique Hopital Habib THAMEUR -TUNISIA

The authors report a study of 60 cases of solitary cyst of bone in child treated between 1980 and 1991.Diagnostic is always clinically and radiologically made.Solitary cyst is caused by an intra tumoral hyperpression in comparison with the marrow direct. The centromedullary surgical treatment assures the drainage of the cystic Cavity and favoriss the fill up of this cavity .Near classification

includes 3 stages : Stage I : complete fill up ,

Stage II : fill up with persistence of residual cyst .

Stage III : recurrence of cyst and iterative fracture with out fill up .

All the operated cases were of the third stage and interested the ¼ of the base at least. Where are essentially proximal humeral and femoral localizations. The montage way depending of the localization of the cyst and the age of the child .

All cases were treated by centro medullary montage .

Inocuity and efficiency of this treatment are demonstrated by absence of immediate or later complication with progressive fill up of the cyst cavity.

TRABELSI M.– CHEHIMI A.– CHERIF M.– M’BAREK M.– ESSADAM H. – ESSAIS M. - BEN HASSINE H.- GHARBI Y.* – ESSAYED S. *

HOSPITOL AZIZA OTHMANA-TUNISIA

*SERVICE DE CHIRURGIE PÉDIATRIQUE HOPITAL HABIB THAMEUR

Trans-condylar elbow dislocation in children is an unknown pathologic entity. This affection is distinguitable of the others elbow dislocations by association of elbow dislocations and an external condyle fracture.

Therapeutically, this lesion is perfectly reducible by orthopedic operation when it’s seen early and don’t require surgical treatment .

A review of 35 cases in ten years illustres the fact that dislocation is not exceptional and representes 12% of elbow dislocation in children and 25% of external condyle fracture in this age.

WAMEEDH KHALID MAKKI

EL BASRAH IRAQ

Since 3 years age first time ILIZAROF device applicated to first patient in our city by Dr Wamedh.

So many lectures are illustrated the advanges of that device procedures of application, so that the idea of treatment the complicated cases that done by classical procedures, was developed the treatment of non united fracture tibia of a man 40 years old who had many classical surgery done to him but no benefit and by ILIZAROF device who have been done for first time by Dr Wamedh ended with surprisingly union, without bone graft.

So latter we work on using ILIZAROF device for 15 cases of different complicated as delayed union of tibia, nonunion and fresh fracture tibia and subtrachanteric fracture femur & fracture humerous, mine injuries, with 13 cm bone , soft tissue and skin loss.

All these cases gained good result. One case gained bad result as infected pseudoarthrosis of tibia and shortening

Advantages :

Three dimensioned apparatus

Bloodless feel (percutanously application)

Easily application

Early weight bearing

Removable apparatus

MAZEN KAKESH – IMAD ABU RUB

AL BASHEER GOVERNMENT HOSPITAL – AMMAN JORDAN

Ewing’s sarcoma is considered to be the fourth primary bone malignant tumour, which arises from neuro echtodermal layer and affect both male and female in almost equal ratio in there first and second decade of life.

It can affect any bone but mainly Metaphyseal and Diaphyseal sites. The bones mostly affected pelvic girdle and the lower limb and upper limb and rare could affect hand and feet of around 1 % of cases.

According to its location special .

So for its various locations, special management of treatment should be taken in consideration.

Our case presentation talks about fifteen years old male patient with history of swelling and pain of the left hand with intermittent fever. Biopsy was taken and the histopathology results shows Ewing’s sarcoma of the third metacarpal bone. Our management consisted of pre operative chemotherapy and amputation followed by chemotherapy.

HISHAM AL-KATTAN

MOSUL UNIVERSITY MEDICAL COLLAGE /DEPT. OF SURGERY

AL- ZAHRAWI TEACHING HOSPITAL -IRAQ

objective:I To describe the beneficial effect of autogenous bone graft for reconstruction of major skeletal defect around the knee.

setting:AL-ZAHRAWI Teaching Hospital.

methods: Two patients with Extensive bone tumours around the knee, one involving lower femur, other upper tibia, stage three according Enneking. Wide enbloc excision with hemicylindrical slab of the tibia, bone carrying done for one of them. Other wide enbloc excision with hemicylindrical slab of the femur. Stability maintained by external fixation. Both patients need repeated surgical procedures.

Union of big skeletal defect obtained after one year and half.

conclusion:Resection arthrodesis of the knee is one of the major surgical procedures, it does need a lot of autogenous bone graft for filling the skeletal defect and needs along time for union and consolidation, even though both patients were happy that their limbs preserved.

TAREK ABDALLA EL-GAMMAL, MD, AMR EL-SAVED, MD

DEPARTMENT OF ORTHOPEDICS, HAND AND RECONSTRUCTIVE MICROSURGERY UNIT ASSIUT UNIVERSITY SCHOOL OF MEDICINE - EGYPT

Unresectable stage IIB malignant musculoskeletal tumours of the upper limb usually treated by amputation which results in great disability and loss of function as there is no prosthesis can replace the function and the sensibility of the hand .The technique of intercalary amputation of the tumour bearing area and replantation of the distal forearm and hand onto the proximal stump offers a salvage option for these patients and retaining some useful hand function. We report four cases treated by this method with satisfactory functional outcome.

TRABELSI M. – CHEHIMI A. – CHERIF M. –. M’BAREK M. - ESSAIS M.- ESSADAM H. – B. HASSINE H.

AZIZA OTHMANA HOSPITAL-TUNISIA

Extra articular reconstruction using free patellar tendon detroned the Lemaire technique since 1993. This last technique distend the transfered tendon (facia lata) and good results decreased after 3 years.

Indications are the same: sedentarity, age superior to 35 years .

The aim is similar (extra articular tenodesis) , bud using free patellar bone – tendon – bone transfer . Bone fixation – is made in external condylian tubercle and in Gerdy tubercle, fixation is made in external rotation.

Preliminor results are satisfactory , the primay fixation is good permitting premature physiotherapie . For active patients, we continue to propose intra articular reconstruction using the same patellar tendon transfer.

SAAD-S-ALANI FRCS

AL - YARMOK-TEACHING HOSPITAL IRAQ

Nine cases present in Trauma and Orth. Dept. AI-Yarmok .T. Hospital suffer from non-united fractures of different parts of body. ( 7 ) cases were male and ( 2 ) were female. 2 affected lower end of humerus, 2 supracondylar of femur, 5 affected tibia.

All were treated by different method of fixation. Using P.O.P-. internal fixation. Or external fixator.

Our method of treatment of non-united by gradual compression then distraction of fracture site using RALCA external fixator.

Cases with sequestra due to previous infection were treated by removal of dead bone, fill area with cancellous bone graft taken from iliac bone.

8 out of 9 were united completely.

ALOUINI R* . ALLANI M* .ZEHIK** .; BOUKADIDA R** ; B.SALAH K* *

* RADIOLOGY DEPARTMENT HOSPITAL IBN EL JAZZAR KAIROUAN.

** SURGERY DEPARTMENT -TUNISIA

Traumatic myositis ossificans is a benign proliferation of fibrous tissue with large amounts of bone within soft tissues.

It typically presents with an unresolved mass following trauma .The differentiel diagnosis includes soft tissue hematoma infection or bone neoplasms.

The authors report one case of 15 year old female suffering from painful swelling of the left shoulder, a history of multiple injuries and the radiographic apperance of ectopic bone formation suggestes the diagnosis of traumatic myositis ossificans .That was documented by histological examination.

TARUK AL ATHRAM MBBCH MANSOUR M. WERFALLY FRCS, MSC. ORTH.

ORTHOPAEDIC SURGERICAL UNIT, TRIPOLI MEDICAL CENTER.LIBANON

We demonstrate a technique of bone grafting in two cases of repeated failure of plate construct associated with non union of fractures of long bones.

A 3D anatomical measurements of iliac crest as a donor site of bone rings, revealed that a single or multiple rings of different diameters are possible to harvest to suite bone length loss closing interfragmental gaps and favour compression.

Clinical and radiological follow-up of bone ring healing over a six months period showed satisfactory bone and periosteal tissue recovery and union with return of good limb function. We do recommend kuntscher or solid (unreamed) nails as tools to hold the ring grafts and fix these damaged sites of non union.

K.F. AFIFI M.D., M.I. SALEM M.D.

JORDAN HOSPITAL – AMMAN

We are reporting two cases in which we faced difficulty during surgery while performing the aimed Total or Partial Hip Arhroplasty.

The first case is a case of hip avascular necrosis in a sickle cell anemia patient. We found that the intramedullary canal was completely obliterated with sclerotic marble hard bone.We will describe how we overcame this problem

by using retrograde reaming of the intramedullary canal.

The second case is a subcapital hip pathological fracture in an 80 year old patient with radiological feature of paget’s disease. In this case, during surgery we found a mixed bone nature (between sclerotic and soft bone).

In this patient we used a long steam Austin-Moore as prophylaxis from future pathological fractures.

This paper discusses thoroughly both surgical cases.

ALOUI S., CHATTI S., BEN FREJ H.,HADDA L, ABDESSELEM MH., CHEKIRT.

UNIT OF RHEUMATOLOGY CHU FARHAT HACHED- SOUSSE-TUNISIA

Spinal arthropathy has recently been described in patients undergoing long term hemodialysis.The radiologic changes associated with it consist of disk-space narrowing and irregular end-plate destruction, strongly simulating an infection.

We report one case of a 62-year-old men undergoing long-term hemodialysis (10 years), who had spinal radiographic finding that simulated disk space infection. MR imaging had excluded infection by showing absence of a prevertebral soft-tissue mass and decreased signal intensity from the disk space and adjacent tissues on all imaging sequences.

The authors analyse the clinical, radiological features of this pathology and discuss its etiopathogenical facts.

TRABELSI M. – ZRIG M. - CHERIF M. – M’BAREK M. – ESSADAM H. –BEN HASSINE H.

AZIZA OTHMANA HOSPITAL-TUNISIA

The diagnosis of bone tuberculosis is facilitated by modern method, however the majority of the practitioners don’t think about. Two cases multifocal bone tuberculosis were reported.

The domage of the spin and the coxo-femoral joint were constant in one case the bochut-tubercle was isolated. The diagnosis was in the two cases late.

After study of the literature the authors conclude that the prognosis may be improved by early diagnosis, and precocious treatment .

MUDHAFFAR K. AL- FALLOUJI , FRCS

HAMMAD SHIHAB MILITARY HOSPITAL. BAGHDAD. IRAQ

This paper shows the difficult problems in the management of bone loss , more so in excessive bone gaps and limb shortening. The causes being traumatic; en- block excision of bone tumour, en- block excision of chronic osteomyelitis. Treatment shown by autograft, allograft or using the sliding - compression technique. the most successful when possible being the autograft for obvious reasons of better vascularity and success of incorporation. However, larger bone gaps show difficulty of graft supply; for which other methods were used as sliding hemi-cortical graft or mobilising fibular pedicle graft by two stage operation. The use of sliding compression system is shown very promising in the management of big bone gaps not amenable to the above mentioned means of treatment.

Special attention was given to bone gaps involving joint when en-block loss of articular ends of major bones, using locally made Salah Eddin sliding system to fill the gaps.

DHIA AK JADDUE

KINDY TEACHING HOSPITAL-IRAQ

The foot problems (ulcer, infection, gangrene....) in diabetic patient, are one of the most common cause of lower limbs amputation. Clinical classification system depends on (the foot and the patient problems);

1. The foot: this depends on type of foot (mainly neuropathies, mainly vascular, or mixed type), type of lesion (deformity, ulceration, infection, gangrene) , and the grade of lesion (depth and extent of the wound).

2. The patient: (presence or absence of significant systemic complications).

The classification and assessment can be documented by using (PFL) (P-Patient, F-Foot, L-Lesion).

This system help in describing the lesion and improve medical communication, as well as lead to more predictable line of treatment and help in giving prognostic outcome (an improve result of treatment) of this complex clinical condition.

F.BELKHIRIA , I.KAMMOUN , M.ZRIG ,H. ESSID , M.HAMDI, L.NOUISRI,  A.KHELIL

DEPARTMENT OF ORTHOPEDIC SURGERY –MILITARY HOSPITAL – TUNISIA

Permanent abduction of the little finger is a bothersome deformity Wich usually occurs in the context of sequelae of ulnar nerve palsy (Wartenberg's sign).

The authors report a preliminary results of 3 cases treated with an original technique for

correction of this deformity .

The extensor digiti minimi tendon is transferred through the extensor retinaculum the "rerouted" tendon is resutured distally on the radial aspect of the interosseous muscle. The distal insertion of the extensor digiti minimi is consequently radialized.

All patients (young-male ) with a mean follow-up of 10 months have a complete active

adduction of the little finger in extension with a persistent capacity for abduction.

ZEHI K. - BOUKADIDA R. - BOUGUIRA A. - FATHALLAH F. - BEN SALAH K. - LITAIEM T. - DOUIK M.

KASSAB INSTITUTE -TUNISIA

The authors report one case of 30 years old male. Surgical excision is followed by regression and disappearance of a neurological signs after an average period of 6 months.

Analysis of same cases appearing in the literature reveals that the symptoms and signs are constant, characterized by the progressive development of paralysis.

CHARFI H. – BACCARI S. – DAGHFOUS M. – ENNOURI K.- TURKI M. –

TARHOUNI L. – BAHRI H.

M.T. KASSAB INSTITUT-TUNISIA

The vascularized nerve graft is an operation described by Strange in 1947 to warrant extending the indications for the procedure to patients in whom traditional repair by direct nerve suture or nerve graft is impossible, because of the loss of several nerve portions.

We report 6 cases of patients with a mean age of 18 years, having and extensive damage nerve. The mean loss nerve was 10 cm.

The etiology was post-traumatic in 5 cases and secondary to a tissue extravasation by antitumour in one. The loss of nerve substance interest the upper limb in 5 cases and the lower limb in one case. In the upper limb, we sacrificed the ulnar nerve in order to graft the median nerve to restore the sensibility of hand.

In the upper land we sacrified the external sciatic poplity nerve to reconstruct the internal sciatic poplity to restore the sensibility of the sole of the foot.

We obtained 3 good results with a sensibility in the median nerve territory estimated to S2 or more.

KHEZAMI M. – CHERIF . – BACCARI S. – TURKI M. – TARHOUNI L. – BAHRI H.

M.T. KASSAB INSTITUT TUNISIA

Nerve complications after axillary techniques for brachial plexus bloks are rare.

We report a study of ten (10) patients analyzed during 10 years (1990-2000) composed essentially of men aged between 22 and 49 years and opered of hand trauma under axillary block.

The most frequent injury interest the median nerve and ist"s often state after a perivascular techniques. This anesthesia complication represent 10%.

FKIH S. – MOURALI M. – EZZAOUIA K. – KOOLI M. ZLITNI M.

SERVICE D’ORTHOPEDIE TRAUMATOLOGIE – EPS, CHARLES NICOLLE – TUNIS

We performed two cases of skin extension procedure for two patients paralyzed who are 18 and 35 years old. The two patients had defect of skin after recidive of sacral and trochanteric pressure sores (3 x 4 cm and 8 x 10 cm). This method who permit a cicatrisation in 6 days was first described by Bachir A.H who published good results since 1987.

We think that is a technique which give a good solution for treatment of the recidive of pressure sores in paralysed patients.

A. MENADI – A. YAHIA – M. BEN MAHMOUD – R. ATIA

DEPARTMENT OF ORTHOPEDICS AND TRAUMATOLOGY IBN ROCHD HOSPITAL ANNABA ALGERIA

The Dupuytren’s disease is a primitive a disease giving a retraction of the middle’s palm’s aponevrosis of the hand and retraction corresponding digital’s chaine also giving disabled retractions.

The authors have practices an aponevrectomy Mac Cash’s type for the cure of this disease to six patients.

After a recding of the years, the results were good also on functionnel and esthetic.

ALOUI S.- HADDA I.- CHATTI S.- HAJ SAL M.- ABDESSALEM MH.- CHEKIR T.

UNIT OF RHEUMATOLOGY CHU FARHAT HACHED – SOUSSE-TUNISIA

The thoracic outlet compression syndrome (TOCS) is a complex of signs and symptoms caused by compression of the vital neurovascular structure at the thoracic outlet region. TOCS has been one of the most controversial subjects in medicine for decades. The diagnosis of TOCS is difficult, based essentially on the clinic features. Initially, TOCS is treated conservatively. Surgery is the last resort. We report a case of women 21 years-old, who consult for left hand and arm pain rising since a few years and recently exacerbated with peripheral nerve compression. The Ross test was positive. X-rays showed an apophysomegaly with no cervical rib. The Doppler showed ischaemia of the left arm especially after abduction and external rotation. Angiography showed an important exterior compression of the median portion of the subclavian vein caused by the scalene muscle. After surgery, there is no symptoms. The authors discuss diagnosis’s and therapeutics’ difficulties of this syndrome.

TAREK ABDALLA EL-GAMMAL, MD, AMR EL-SAVED, MD, MOHAMMED EI-SHARKAWI

DEPARTMENT OF ORTHOPEDICS, HAND AND RECONSTRUCTIVE MICROSURGERY UNIT ASSIUT UNIVERSITY SCHOOL OF MEDICINE EGYPT

Increasing interest in instrumentation of the spine has resulted In

significant infection rate. Mild to moderate infection usually resolves with debridment and local wound care . However, severe infection associated with sloughing of the skin and muscle of the back , although rare, present a significant problem.

We report a case of severe infection after instrumented lumbar spine decompression fusion with soft tissue defect 15x10 cm exposing the metal and the dural sac successfully treated by Latissimus dorsi flap used for coverage and control of infection.

S.KAMMOUN , H.KSIBI , S.KARRAY , H.B.AMOR , S.KALLEL , M.ZOUARI , T.LITAIEM , M.DOUIK , N.SLIMANE

KASSAB INSTITUT TUNISIA

The prognosis of Legg-Calvé-Perthes Disease depends on the evolutionary stage when the disease is discovered together with the precocity of treatment.

We report the case of a 5 year old child recovered from an osteochondritis of the left hip, stage III, according to Caterall grading .He was treated by Salter innominated osteotomy followed by a one month traction, then 2 months of cast immobilization .

The evolution was favourable with good sphericity of the head and an adequate congruence of the hip enabling him to practise football in competition during 10 years.

With the 30 year retreat, the patient is asymptomatic, the mobility of the hip is normal and radiographs do not show any sign of hip osteoarthritis .

ZRIBI M. – ZRIBI W. – TRIGUI M. – TOUNSI N. - AYADI K. – KESKES H. – GARGOURI J.

SERVICE D’ORTHOPEDIE - C.H.U. HABIB BOURGUIBA-TUNISIA

Authors report the experience of the bank of bone in Sfax which begun since 1995. The activity of this unit was based on the conservation of the femoral head at the time of prosthetic replacement of this one after fracture of the femoral collar.

The number of donors was 30 : the receivers were 19.

Indications of the bony allograft were multiple : pseudarthrosis ; Bony tumours, osteo-aticular infections …

After presentation of their result, authors advance projects of this unit in particular the widening of this experience toward the conservation of diaphyses and metaphyses of long bones.

BETTAIEB I. – HSAÏRI M. – BEN AMOR H. – TRIGUI S. – KALLEL S.-ZOUARI M. - KARRAY S. – MRABET A. – LITAIEM T. – DOUIK M.

KASSAB INSTITUT TUNIS

The Aneurysmal bone cyst is a benign which rarely affect the clavicle.

We report one case of a sixteen years old child who consults for a lasting right sub-clavicular tumefaction. X-rays show lysing tumor of the right clavicle with a notable limits and without any expansion to soft tissues. We complete the exploration with a scanner and arteriography, which do not show any compression of subclavicular vessels.

The treatment was a subtotal cleïdectomy leaving the external quarter of the clavicle. Histology concludes at an aneurysmal bone cyst. After 10 year’s follow-up, the result was good with normal function and mobility of the shoulder.