Purpose of the study: Pott’s disease of the cervical spine is exceptional. We collected 27 cases over a period of 30 years.

Material and methods: Mean patient age was 21 years. Male gender predominated. Most patients consulted because of cervical pain and 50% presented neurological disorders. Mean duration of symptoms was 14 months. A peri-spinal abscess was found in ten patients. The posterior cervical spine was affected in most patients and four presented suboccipital involvement. There was associated lung disease in two-thirds of the patients. Standard anti-tuberculosis chemotherapy was given associated with traction alignment in twelve patients to correct for kyphosis or associated spinal dislocation. Surgery was reserved for major bone destruction leading to instability or neurological disorders resistant to medical treatment.

Results: Mean follow-up was five years. The anatomic result after medical or surgical treatment was characterized by vertebral fusion in all patients. There were three serious neurological complications after surgery. Improvement was achieved in eleven of the twelve patients with inaugural neurological complications.

Purpose: Aneurysmal bone cyst is a benign osteodystrophic pseudotumor. It can occur as a primary lesion or develop on a pre-existing lesion. The etiopathogenesis, diagnosis and treatment remain subjects of interest.

Material and methods: For this retrospective analysis, we collected 48 peripheral aneurysmal bone cysts over a 27-year period. Most cysts occurred in children, adolescents, or young adults, with a slight female predominance. Imaging included standard x-rays, computed tomography, and for the more recent cases magnetic resonance imaging (MRI). MRI provided new imaging features increasing diagnostic accuracy. Second readings of histology slides enabled establishment of the correct diagnosis in certain cases but differential diagnosis was established only with benign tumours. Surgical treatment predominated. Other treatments included curettage-filling with cancellous bone, resection, resection-reconstruction,curettage-filling with cement. Adjuvant treatments mainly involved use of calcitonin. Therapeutic abstention with surveillance confirmed the possibility of spontaneous regression after biopsy. Curettage-filling with cancellous bone was performed in 58% of cases, giving an Enneking function score of 95.7%.

Results: We reviewed outcome at mean 7 years follow-up. There were four recurrent cysts and the mean global Enneking score was 95%. Our series showed the several methods can be used for the treatment of aneurysmal bone cysts, the indication taking into consideration the patient’s age, the location of the lesion and is progression. We propose a therapeutic schema. The role of calcitonin remains to be determined.

Conclusion: The diagnosis of bone cysts requires a close collaboration between the surgeon, the radiologist, and the pathologist. The indication for surgery must be made case by case to achieve cure without sequelae.

Purpose: Surgery is generally proposed for the treatment of giant-cell bone tumours but other options are discussed. The problem is to decide between curettagefilling and enucleation, using or not local adjuvant treatment with curettage, and filling with an autograft, an allograft, or cement. The purpose of this work was to provide a new perspective to the treatment of giant-cell tumours based on the tumour pathophysiology and calcitonin infiltration.

Material and methods: We report 25 cases of benign giant-cell tumours treated by calcitonin. Mean patient age was 31 years. Female gender clearly predominated (75%). All of the tumours were located at the extremity of long bones. We grouped the tumours as quiescent benign tumours, and active or aggressive tumours according to the Enneking classification. Our treatment protocol included four stages after histological confirmation of the diagnosis on the biopsy specimen. The first stage was aggressive curettage, followed by intramuscular injection of calcitonin until cutaneous healing. The third stage involved daily washing of the tumour cavity with saline solution for one month. The final stage lasted two months with intramuscular injections of calcitonin.

Results: We analysed outcome at mean three years (range 2 – 20 years). Progressive filling of the tumour cavity was observed in the majority of patients starting with the first month of treatment even for the aggressive forms where tumour resection was tempting. Using the Enneking scale, our rates were near 90%, largely above the rates obtained with other conventional techniques. There were no complications. We did however have eight cases of recurrence including three which were treated again with the same protocol with good outcome.

Discussion and conclusion: Giant-cell bone tumours are clearly hormone sensitive. Calcitonin would appear to arrest the osteolytic process by attacking the osteoclast-like cell which bears calcitonin-receptors. Daily washing of the tumour cavity is designed to modify the microenvironment and eliminate tumour growth factors and cytokines expressed by giant-cells. More detailed studies of the cell membrane might reveal an explanation of certain calcitonin escape phenomena which are the cause of more or less long-term recurrence.

Purpose: Osteoid osteoma is a benign small-sized painful osteoblastic tumour usually observed in young subjects. The purpose of this work was to study the epidemiological, clinical, radiological, and histological features, focusing on clinical course after treatment and differences by location.

Material and methods: We report a retrospective series of 56 osteoid osteomas located in limbs treated over a 25-year period from 1976 to 2001. The tumour involved the femur (n=21), the tibia (n=14), the hand (n=8), the foot (n=7), and the olecranon, the lateral humeral condyle, the humeral neck, and the acetabulum (n=1 each). Pain was the pain symptom, found in all patients. The aspirin test was positive in 82%. The joint locations led to an arthropathy in 87%. The typical nidus aspect was found on 78.5% of the plain x-rays. Computed tomography was performed in 25 patients and scintigraphy in 10. Magnetic resonance imaging was performed in 4. Surgical treatment consisted in en bloc resection (n=48), intra-lesions curettage (n=6), computed tomography-guided percutaneous resection (n=2). Mechanical protection was obtained with a plaster cast (n=21) and osteosynthesis material (n=7). A bone graft was used in 22 patients. Pathology confirmed osteoid osteoma in all patients. Lymphocyte plasma cell infiltrations were observed in seven of the articular localisations.

Results: Mean follow-up was 5 years. Complete pain relief was achieved after a single resection in 53 patients and after re-operation of a second resection in the others. For the joint localisations, complete joint movement was recovered in three-quarters of the patients. Postoperative x-rays were performed in all cases. The main early complications were iatrogenic fracture (9%), mainly in patients with a tibial tumour. Late complications included osteoarthritis for the acetabular tumour and two cases of talal degeneration.

Conclusion: Osteoid osteoma is an uncommon tumour general easy to recognise. Atypical clinical and radiological presentations are rare. Computed tomography is the key to diagnosis and provides important therapeutic information.

Purpose: Leg fractures are a daily problem in orthopaedic surgery. The frequency has increased due to the growing number of traffic accidents. Social impact is important because the injured population is young and active. The purpose of this work was to analyse anatomic and functional results obtained in a series of patients and to identify indications and limitations of centro-medullary alignment nailing for the treatment of leg fractures.

Material and methods: This series included 207 leg fractures treated with this method at the Kassab Orthopaedic Institute. There were 174 men and 33 women, mean age 35 years (15–75). Male predominance was considerable (84%). Centromedullary nailing was completed with a plaster cast and weight bearing after a mean four to five weeks with a Sarmiento walking case until bone healing.

Results: Results were analysed at mean 12 months follow-up (4 months–18 years). Bone healing was achieved in 99% of the cases within a mean time of 15.3 weeks (6–66 weeks). There were 16 cases with a deformed callus (7.8%) predominantly in varus (n=10) and thirteen secondary dislocations (6.3%). This was significantly more frequent for fractures of the proximal third in comparison with the mid third, or comminutive bifocal fractures, and when weight bearing occurred before the fourth week.

Discussion: The functional outcome showed pain at walking in 15% of the patients. Walking distance was unlimited in three-quarters of the patients and joint motion was good. Alignment nailing is a reliable easy to use technique providing satisfactory results for the treatment of simple fractures of the mid third of the leg. Fractures of the upper and lower third, as well as bifocal and comminutive fractures require a locked nail to neutralise the risk of secondary displacement and misalignment callus.

We report the management of two children and 11 adults with paraplegia secondary to vertebral hydatidosis. Destruction of pedicles, posterior vertebral elements and discs as well as the vertebral bodies was common and all six patients with thoracic disease had involvement of adjacent ribs. The 13 patients had a total of 42 major surgical procedures; two patients died from postoperative complications and four from complications of the disease and paraplegia. All eight patients initially treated by laminectomy or anterior decompression alone relapsed within two years and seven required further surgery. Circumferential decompression and grafting gave the best results, six of nine patients being in remission an average of three years and six months later. The prognosis for such patients is poor; remission is the aim, rather than cure. Anthelminthic drugs may improve the prognosis, but radical surgery is likely to remain the keystone of treatment in the foreseeable future.