Purpose of the study: Surgical management of neurological injury encountered in patients with a ruptured pelvic girdle remains exceptional. In this work, we present our experience and compare our results with data in the literature.

Material and methods: This retrospective analysis concerned four clinical css. Mean patient age was 20.2 years for two men and two women. All patients were victims of high-energy trauma and presented type C (Tile) pelvic girdle injury. All presented a paralysis of the lumbosacral plexus. One patient presented bilateral paralysis of the pudendal plexus. The work-up included: saccora-diculography, myeloscan, lumbar magnetic resonance imaging. One patient presented a pseudomeingocele.

Results: Surgical exploration was performed within a mean delay of 3.75 months. Two types of exploration were used: for two patients the transperitoneal approach was used because of a suspected lesion of the lumbosacral trunk and for two others, the trans-sacral approach because of suspected intra-spinal rupture. Neurolysis was performed for three patients and an caudia equina nerve graft for one. Nervous injuries involved section or rupture of the roots. There were no cases of medullary avulsion. All patients presented signs of nerve regeneration at last follow-up (mean 5.5 years).

Discussion: Even though injury to the lumbosacral plexus is exceptional, advances in surgical techniques offer therapeutic options adapted to each type of injury and nerve territory. One or more motor functions can be restored. Microsurgical nervous repair of the lumbo-sacral plexus is possible irrespective of the level of the injury. Nerve repair by grafting or neurotization can be achieved via a combination of trans-sacral and anterior retroperitoneal approaches or even a transabdominal approach.

Purpose of the study: Balistic nerve injury is not common in civil medicine. We analyzed a series of 30 patients who underwent surgery for this type of injury suffered in the Gaza strip between 2002 and 2004. All patients presented paralysis of the sciatic nerve or one of its major branches. All injuries were caused by war weapons.

Material and methods: The series included 28 men and two women, mean age 22 years (range 2.5–65). The injury had occurred more than one year earlier for 33% of patients. The injury was situated at the knee level in twelve patients and in the thigh in ten. Complete nerve section was observed in 12 patients and partial section in two. Loss of nervous tissue was significantly greater for lesions around the knee. Nineteen patients underwent surgery for: neurolysis (n=3), direct nerve suture (n=8) and nerve grafts (n=8). Eleven patients were reviewed at mean 13.7 months (range 3–30 months). There were no failures. Results of reinnervation of the tibial nerve territory were better than for the fibular nerve. Sixteen patients underwent palliative transfer for a hanging foot for more than six months: 15 transfers of the posterior tibial muscle through the interosseous membrane and hemitransfer of the Achilles tendon. Seven patients underwent Achilles tendon lengthening at the same time and five had a reinnervation procedure on the common fibular nerve.

Results: Seven patients were reviewed with a mean follow-up of 1.8 years (range 4–30 months. None of the patients used an anti-equin orthesis. There were three cases of forefoot malposition. The overall Stanmore score was good at 75.4/100 (range 59–100).

Discussion: High-energy ballistic trauma creates a specific type of injury. Nervous surgery can be indication early to favor spontaneous recovery. Palliative surgery for fibular lesions provides regularly good results.

Conclusion: Nerve injuries due to ballistic trauma should be explored surgically because of the possibility of direct nerve repair. In addition, depending on the type of paralysis, reliable palliative surgery can be proposed.

Purpose: Intra-osseous leiomyosarcoma (IOLM) is a rare tumour. Imaging aspects are not specific. Pathology is required to establish diagnosis. The appropriate treatment remains controversial because no method has demonstrated certain efficacy. We report two cases and review the literature on this malignant tumour.

Material and methods: The first patient was a 43-year-old woman who suffered right knee pain for six months. Plain x-rays of the tibia revealed an metaphyseo-epiphyseal zone of osteolysis with soft tissue involvement as did 18-FDG uptake on the scintigram and computed tomography. Pathology diagnosis was high-grade IOLM. Search for extension was negative. Tumour resection was performed with implantation of a massive prosthesis followed by chemotherapy and radiotherapy. The second patient was a 50-year-old man who was referred ten days after spontaneous fracture of the lower femur. Plain x-rays, computed tomography and magnetic resonance imagine as well as the PET-scan were difficult to interpret. Pathology examination of a biopsy specimen was in favour of a benign lesion. The final diagnosis was IOLM. Search for extension was negative and radiotherapy was given.

Results: At mean 18-month follow-up, both patients were living. The first patient was able to walk without crutches and the second patient achieved bipodal stance with crutches. Radiologically, the prosthesis was stable and the graft healed. Positive diagnosis was established on the basis of immunohistochemistry and study of the ultrastructure. Unfortunately, treatment of this malignant tumour remains difficult. Chemotherapy and radiotherapy are ineffective. Surgical treatment, even when oncological resection can be achieved, has not demonstrated superior efficacy compared with more conservative treatment in terms of survival or secondary spread. Associating medical and surgical treatment does not guarantee a better result.

Conclusion: IOLM is a rare tumour which requires immunohistochemistry and study of the ultrastructure for positive diagnosis. The appropriate therapeutic option cannot be established, but it would appear that tentatively curative surgery associated with radiotherapy may provide better outcome despite the poor short-term prognosis.