Case presentation: Woman, 57 years old, paraplegic due to a car accident 1 year earlier, presenting with bruises on the anterior surface of both legs after suffering a direct trauma to that area. The radiographic examination revealed tibial and fibular metaphyseal fractures, bilaterally, as well as a reduced bone mineral density. Both knees were immobilized with bandages temporarily, being replaced by knee orthosis on the following day, for better evaluation of the skin and to prevent skin lesions or other complications due to the use of a cast in a limb with a sensory impairment. The patient used the orthosis fulltime for 2 months, followed by intermittent use for 1 more month, according to the clinical and radiological evolution. Three months after the fracture, the orthosis was removed and physiotherapy was initiated. During follow-up, two months later, the patient has shown a good clinical and radiologic evolution with fracture consolidation and correct alignment of the bone fragments. Discussion: Even though modern techniques allow surgical interventions in bones with reduced mineral density, non-unions remain a common complication. The adequate treatment for a certain type of fracture is not only based on the pattern of the fracture, quality of the bone and associated injuries, but also on the patient’s status, such as age, functional level, prior disabilities and comorbidities.

Introduction:The Vacum Assisted Closure(VAC)system provides effective healing in extensive wounds with loss of cutaneousmuscular substance.Its principle is based on application to the wound of a negative pressure system which promotes healing by reducing bacterial proliferation, stimulating neoangiogenesis.These mechanisms gradually decrease the size of the wound and promote the creation of healthy skin tissue,provided that the wound is dewaxed and surgically removed before each procedure to ensure its effectiveness.Success with this type of negative pressure healing results in complete re-epithelialization at best,but sometimes secondary wound closure or skin grafting may be necessary.Materials and methods:We report an observation of 3 cases aged70,83and65 years,very poorly balanced diabetic who consulted at our level for extensive necrosis of the foot with infiltration of the leg,the patient was amputated at level 1/3 upper leg,after equilibration of diabetes and several dressings the stump was infected unhealed with the onset of necrosis,after necrectomy the VAC negative aspiration system was put in place. Results:The suction system was maintained in this patient,the size of the wound clearly decreased from the first dressing which prompted us to continue this method,and we obtained complete healing after two months, with a good stump.Discussion:Numerous works,mostly reporting experiences of the use of VAC on small series of patients,have been published.In the treatment of Fournier's gangrene,the VAC system has reduced the frequency of dressings and the duration of hospitalization. Conclusion:Considering its effectiveness,the VAC system seems very useful for obtaining healing of complex wounds and is currently an effective technique in the therapeutic arsenal available to surgeons.

Introduction: The diabetic foot constitutes a major problem of public health; he is responsible frequent amputation and can be life-threatening, the management of diabetic foot is multidisciplinary and requires special care. Material and method :
We report an observation of a 55-year-old patient, poorly balanced diabetic, who presented with neglected plantar perforating disease which progressed to wet necrosis of the dorsal surface of the 4th and 5th ray, after bacteriological samples, re-balancing of diabetes, under adequate antibiotic treatment, we proceeded to amputation of the 4th and 5th ray, and recovery by a plantar flap slipped on the dorsal surface, in order to obtain skin coverage. Result: healing was slow, repeated dressings were applied, but the progress was good and the patient resumed walking and his socio-professional life.
Discussion: The management of the diabetic foot requires a multidisciplinary team, which takes care of the various problems: early diagnosis, etiological assessment, medical or surgical therapeutic indications, treatment of the infection, optimization of the diabetes balance, local care. The role of the orthopedic surgeon is central because he must reason in terms of biomechanics to avoid, after conservative or surgical treatment, the creation or persistence of hyper-support zones. Conclusion: The prevention of diabetic foot lesions, difficult but crucial, is dominated by therapeutic education of patients, pedicure care, fitting with plantar orthotics, orthopedic shoes.

Methylprednisolone is a corticosteroid hormone used to treat pain and swelling that occurs with arthritis in orthopedic practice. It is also be used to treat severe allergic reactions, certain cancers, some eye conditions, skin/intestinal/kidney/lung diseases and immune system disorders. It decreases body immune system's response to these conditions and reduces symptoms such as swelling, pain, and allergic-type reactions.
After intra-articular injection, corticosteroids function to suppress inflammation and decrease erythema, swelling, heat, and tenderness of the inflamed joint.

But some local reactions at the injection site may include pain, swelling, tenderness, and warmth, all of which may develop a few hours after injection and can last up to two days.
A post injection steroid flare, thought to be a crystal-induced synovitis caused by some preservatives in the injectable suspension, may occur within the first 24 to 36 hours. This is usually self-limited and responds to application of ice packs for no longer than 15 minute intervals.
The purpose of this study was to reduce the pain caused by injection.
We add 4 mg dexamethasone injection to depomedoral (40 or 80 mg). It reduces the pain of the injection; it reduces pain by anti-inflammatory to the preservatives of injection depomedoral.
More than 100 patients were tried; all were free from this unwanted pain.

Background: It is widely accepted that DPC is crucial for performing the SBET. The effects of a flexibility programme and CGs on SEBT performance are unknown. This study combined CGs and a series of static stretched to address this issue. Aim: This study aimed to discover the effects CGs and a 6-week flexibility programme could have on SEBT reach distance and DPC. Method: Thirty-five participants were instructed to attend 3 testing sessions (BASE, PRE and POSTINT). The POSTINT session followed 6-weeks of flexibility training. Maximum reach distance on the SEBT was used as the primary outcome measure. Participants were tested twice for each limb, once with and once without CGs. Results: CGs significantly increased SEBT composite score for the right limb (4.14% and 2.45% at BASE and PRE respectively (p<0.001)). SEBT composite score for the RL after the flexibility programme when wearing CGs increased by 5.2% (p<0.001), whilst composite score for the LL with CGs increased by 3.19% (p<0.001).
Significant increases in RL MAXD% in the ANT (5.65%), AL (3.03%), LAT (5.72%), PL (4.50%) and POST (5.91%) directions were noted when wearing CGs after the flexibility programme. Significant increases in LL MAXD% in the ANT (5.09%), AL (4.99%), LAT (4.56%) and PL (4.12%) directions were found when wearing CGs post-intervention. Conclusion: CGs immediately increased SEBT reach distance. Significant increases in reach distance were also seen when CGs and a 6-week flexibility programme were combined. These findings show flexibility training and CGs can improve DPC in a healthy population.

Abstract Content Test 2