Introduction: Pandiaphysitis is a particular form of chronic osteomyelitis by the extent of infection on the diaphysis but also the risk of complications. It is disabling, tenacious, potentially life-threatening and is common in our developing countries where it is a public health problem.

Objective: To describe the anatomo-clinical and therapeutic aspects of pandiaphytes in the orthopedic and trauma department of a low-income country.

Material and method: This is a retrospective study from January 2009 to December 2016. We included patients treated in the department and whose file was complete.

Results: We collected 29 cases of pandiaphysitis. The average age was 23.69 years old. There was a clear predominance of the male sex with a ratio of 3.83. The only land found was sickle cell disease (4 cases). Bloodborne infections were predominant. The consultation period ranged from 1 to 33 years. The preferred seat was the lower limb with 65.52% of cases. On radiography, the sequestering form was the most represented. The stapyloccocus aureus germ was the most represented organ (75% of patients). Antibiotic medical treatment was systematic (patients being received at the pushing stage). Surgical treatment was done in 25 patients. After evaluation, we had 44.83% favorable evolution. Complications and sequelae have been observed: recurrence, unequal limb length, deformities and one case of death.

Conclusion: Pandiaphysitis is a serious pathology, causing multiple sequelae that negatively impact the quality of life of patients. Acute outbreaks can cause fatal sepsis.

Introduction: Graves’ disease (GD) is one of the organ-specific autoimmune thyroid diseases, while SLE is an autoantibody mediated systemic autoimmune disease. A literature review lends itself to the known association of hypothyroidism, autoimmune thyroiditis, thyroid cancer but rarely hyperthyroidism to systemic lupus erythematosus in age and sex matched controls. About one third of the patients with autoimmune thyroid diseases are Anti-Nuclear Antibody (ANA) positive. About one tenth of patients with autoimmune thyroid diseases, who are ANA positive, may also be positive for other lupus antibodies such as Anti-Double Stranded DNA (Anti-dsDNA), Anti-Ro, and Anticardiolipin (aCL). The association of Anti Smith Antibody positive SLE and Graves’ disease is extremely rare in adults and none reported in the pediatric population.

Case presentation: An 11-year-old Caucasian female from mid-Missouri was diagnosed with Graves’ disease and was started on Methimazole. On day 30th of therapy, she presented with small joint arthritis and eventually was diagnosed as systemic lupus erythematosus by the Rheumatologist. This is the first case report of overlap syndrome of juvenile Graves’ disease and anti-Smith antibody positive juvenile SLE in the pediatric population.

Discussion and Conclusions: The coexistence of GD with the SLE could be explained as a part of the lupus syndrome, an overlap disease, or drug induced lupus due to methimazole therapy in a Graves’ disease patient. It is utmost importance to identify the correct diagnosis to estimate the current treatment and long-term outcome of the patient. It appears from the published literature that the coexistence of thyroid abnormalities and lupus does not affect mutual disease activity, though the type of association affects the patient outcome (REF).

Introduction: Management of pain in patients with knee osteoarthritis remains a challenge due to patients’ age, comorbidities, necessity of medicines such as Nonsteroidal Anti-Inflammatory Agents (NSAIDS) should be taken for a long period, and this raises the requirements for well-tolerated medicinal product such as amtolmetin guacil whose gastro sparing action is mediated though increasing of Nitric Oxide-synthesis.

Patients and methodology: Fifty patients aged 50-69 years with knee osteoarthritis of stage II- III by Kellgren& Lawrence scale, were enrolled in the study. Patients were divided into 2 groups. Group I (30 patients) was assigned for amtolmetin guacil (AMG) tablets, 600 mg twice daily (Niselat, produced by Dr Reddys Laboratories Ltd) and group II (20 patients) was assigned for diclofenac sodium (DS) tablets, 50 mg twice daily. Duration of treatment was 1 month. Patients were assessed by WOMAC questionnaire, Lequesne Index, functional movement assessment. All adverse events reported were documented during the study period.

Results: The efficacy of treatments, as assessed by pain intensity (WOMAC) showed that AMG was associated with a significant reduction in pain intensity as compared to diclofenac by 30 days, 55% and 30% respectively. The improvement in functional abilities was significantly better with AMG as compared with DS by day 20 (35% and 24% respectively), and day 30, (50% and 30% respectively). AMG was well tolerated and was not associated with gastrointestinal adverse effects and hepatic function. In patient who completed 30 days of treatment, AMG was more frequently accessed as having “improvement” or “substantial improvement” as compared to DS.

Conclusions: Amtolmetin guacil is an effective treatment for knee osteoarthritis and provides better reduction in pain and improvement in functional abilities of patients. The better safety profile of AMG makes it a choice of treatment for the older patients and patients with high risk of gastrointestinal complications.Good patient tolerance to the treatment and high level of patient assessment of treatment efficacy should positively impact compliance and treatment efficacy.

We report the case of a 27 year old male who presented with persistent and unresolved shoulder pain status post shoulder arthroscopy for a SLAP lesion. A thorough history, examination, and laboratory analysis yielded the diagnosis of Rocky Mountain Spotted Fever (RMSF), a rare cause of monoarticular joint pain. After appropriate treatment with oral doxycycline the patient’s symptoms resolved. This case stresses the importance of remaining cognizant for non orthopaedic causes of joint pain during orthopaedic clinical evaluation. This case represents a rare manifestation of RMSF as inflammatory arthritis of the shoulder.

Purpose: Calcium phosphate ceramics have been widely used as biomaterials for regeneration of bone tissue because of their ability to induce osteoblastic differentiation in progenitor cells. Calcium Phosphate Cements (CPCs) are prepared from different calcium phosphate powder precursors by mixing them together with aqueous phase followed by setting and hardening into monolithic solid. This article provides an overview on the chemistry, kinetics of setting and handling properties such as setting time, cohesion and injectability of CPCs for bone substitution, with an emphasis on their mechanical and biological properties. The processing parameters that can be adjusted to control the setting process, injectibility and cohesive strength are discussed. CPCs are currently used for repair of non-load bearing bone defects due to its brittle nature and low flexural strength. Processing strategies to improve mechanical strength, fracture toughness and reliability of CPCs are also highlighted here. Further, a systematic discussion on the effects of physical (e.g. surface roughness) and chemical properties (e.g. solubility, crystallinity) of CPCs on protein adsorption, cell adhesion and osteoblastic differentiation in vitro is presented. Moreover, the physical and chemical properties of CPCs that govern its efficacy as carrier and candidate biomaterials for controlled release of variety of drugs and bioactive molecules are elaborated. Future research directions to improve the performance of CPCs are highlighted and briefly discussed.

Results: There are mainly two types of CPCs such as apatitic and brushitic that differ in their setting and hardening kinetics and in general brushitic CPC exhibits faster setting kinetic and lower mechanical strength. Setting kinetics, injectability and cohesive strength of both types of CPCs can be regulated by varying powder particle size, polymeric additives and viscosity of mixing liquid. The shortcomings in mechanical properties of such type of cements can be addressed by using bimodal size distribution of precursor particles, incorporating dual setting character in the cement or by preparing biodegradable or bioinert fiber reinforced cement composite. Calcium phosphate cement appears to possess excellent biological properties. CPC properties such as surface charge, crystallinity, slower and controlled degradation, micro and macro tomography positively influence several chronological events such as protein adsorption and cell adhesion that ultimately governs osteoblastic differentiation of progenitor cells. Because of its macro and micro porous structure, CPC serves as an excellent candidate to incorporate drugs and other bioactive molecules, to retain it in a specific target site, and to deliver it progressively with time in the surrounding tissues, by virtue of its biodegradability. Due to its poor mechanical properties, CPCs’ clinical applications are currently limited to craniofacial reconstruction. Further research is necessary to exploit its excellent biological properties with concomitant strengthening of mechanical reliability for its widespread clinical applications.

Conclusions: CPCs possesses a huge prospect to serve as next generation bone substitute material and further research is necessary to ameliorate its performance under clinical situations.