We present the case of a 26-year-old patient who came to the emergency department for aggression with a puncture injury (ice picking) at the T12 thoracic vertebra.

Introduction: Popliteal artery injuries are frequently encountered in case of fractures, dislocations or after penetrating trauma. Lower limb blunt traumas are associated to popliteal artery injuries in 28 to 46% of cases.

Objective: Our objective was to report this particularity.

Clinical examination: The evaluation of the tibial plateau fracture was performed with the Schatzker classification. The nervous injury was classified according to the Seddon classification. We did not find a classification for post-traumatic acute arterial injury

Results: There was a motor deficit of the common fibular nerve without sensitive deficit. The radiological examination showed a complex bicondylar fracture Schatzker 5.

An open reduction and internal fixation with a buttress plate was planned and performed 4 days following the trauma.

The postoperative follow-up was marked by the appearance of a distal necrosis of the 1st and 4th toes with coldness of the forefoot one week after the operation; the pedal and retro-tibial pulses were diminished. Doppler ultrasound and Angio-scan revealed a narrow stenosis of imprecise etiology due to artefacts related to the osteosynthesis material, however, there was a substitute blood network. The patient received curative-dose anticoagulants combined with Sintron and Aspegic.

Discussion: Penetrating trauma is the main cause of vascular lesions in the extremities. They are followed by closed trauma including traffic accidents, falls and crushing. In addition, closed trauma can lead to slow progression of arterial insufficiency.

Inadequate initial examination and delayed vascular repair lead to amputation in 60-80% of cases. It is therefore of paramount importance to evaluate the vascular state not only at the initial examination but above all repeatedly in the following hours and days. In our patient, edema was one of the factors which made difficult the proper monitoring of the distal pulse. Therefore, it seems appropriate to include in the monitoring of knee trauma, whether or not there is a fracture of the tibial plateau, more tests such as Doppler ultrasound, angiography, Angio-scan and MRI.

Conclusion: The dogma which recommended the realization of MRI or even Angio-scan of the knee only after dislocations should be extended to the fractures of the tibial plateau especially in a context of high velocity and this at the beginning and at the end of the management.

This report is of a 20-year-old woman with an osteochondroma of the proximal fibula with scalloping of tibia who presented with chronic pain and swelling in the right popliteal fossa that had been present from 3 years. Magnetic resonance imaging findings can’t enable accurate diagnosis because of the similarities between osteochondroma and low-grade chondrosarcoma. Thus, biopsy of this tumor was necessary. Extemporaneous Histopathological examination confirmed the benign nature of osteochondroma, thus, we performed debulking of the tumour with complete excision.

Objectives: The aim of this multicentre study was to determine the effect of oral alendronate over 2 years on Bone Mineral Density (BMD) and bone turnover in patients with Ankylosing Spondylitis (AS).

Methods: 180 patients were randomised to receive alendronate 70 mg weekly or placebo. Change in BMD over 2 years was assessed by Dual X-Ray Absorptiometry (DXA) scan, bone turnover by serum markers (Procollagen Type 1 Amino-Terminal Propeptide (P1NP) and Carboxy-Terminal Collagen Crosslinks (CTX)) and vertebral fracture by bone morphometry.

Results: At 2 years, patients in the alendronate group showed a significant mean increase in BMD of 5.6% at the lumbar spine compared to a mean increase of 1.4% in the placebo group. At all regions of the hip, BMD increased significantly in the alendronate group. There was a non significant decrease at all hip site in the placebo group. Serum markers showed a significant (p<0.001) reduction in bone turnover in the treated group but not in the placebo. No incident morphometric vertebral fracture rates were observed in either group.

Conclusions: Oral alendronate is effective at reducing bone turnover and increasing BMD in patients with established AS. Although not demonstrable in this short study, an effect on fracture risk is likely to be seen in a higher risk group treated over a longer period.

Introduction: Isolated fractures of the sacrum are rare and in principle related to a direct posterior shock. The occurrence of a pseudarthrosis of a sacrum associated with neurological disorders is an exceptional eventuality.

Case: Female subject 38, victim of a traffic accident occurring 3 months previously, consulted for a neglected trauma of the left hemi pelvis with relative functional impotence of the lower left limb. Clinical examination resulted in a painful lameness with a makeshift cane, pain in inguinal palpation and mobilization of the left hip. The gluteus medius muscle was rated at 0. There were no sphincteric disorders.

Observations: The standard X-ray showed a fracture of the left ischiopubic branch. At CT, there was also a vertical fracture of the left hemi-sacrum passing through the sacral holes and a fracture of the anterior column of the homolateral acetabulum.

The electromyogram showed a left L5 and S1 radiculopathy, a truncular involvement of the SPI (myelinic type) and of the left SPE (axonal type).

At 6 months of follow-up and after a medico-physical treatment (analgesic of pallium-II, vitamino-therapy B and functional rehabilitation); the patient fully recovered with pain only squatting and a gluteus medius to 5.

Results and Conclusion: In traumatology of the pelvis, the standard images are often ill-readable, hence the interest of CT. In the absence of displacement and / or root compression, functional treatment is mandatory. The occurrence of a pseudarthrosis associated or not with irreducibility or a persistence of the neurological syndrome indicates a surgical approach.