Utilisation de l’échocardiographie Doppler dans la prise en charge des lésions cardiovasculaires traumatiques

Over the last decade, the initial assessment of patients presenting with a severe thoracic trauma changed dramatically. Angiography, historically considered the reference imaging modality for the diagnosis of traumatic aortic injuries (TAI), has been supplanted by non invasive techniques. Multiplane transesophageal echocardiography (TEE) or contrast-enhanced helical computed tomography of the chest are first-line imaging techniques currently used in most trauma centers for the screening of patients with suspected TAI. With the respect of a learning curve, TEE is an accurate imaging modality for the diagnosis of TAI and blunt cardiac trauma. In addition to its diagnostic capability, TEE provides valuable information which help guiding the therapeutic management of injured patients. The acute management of patients presenting with a precordial wound is mainly based on the early diagnosis of hemopericardium which should prompt surgical repair of an underlying cardiac injury. Accordingly, transthoracic echocardiography is the pivotal test performed upon admission, whereas TEE is usually performed peroperatively to precisely identify associated cardiac injuries. In summary, echocardiography Doppler is a pivotal imaging modality for the assessment of patients at high risk of sustaining blunt or penetrating cardiovascular trauma. This implies a consistent availability of full-featured echocardiographic systems and trained operators in trauma centers.     

Complications des fractures–décollements épiphysaires de l’extrémité inférieure du tibia et de la fibula. Étude d’une série de 81 cas

Distal tibial and fibular epiphyseal fractures are common in children. Those lesions, usually benign, could produce damage to the growth plate with angular deformities and leg-length discrepancies.