Kyste hydatique primitif de la cuisse révélé par une cruralgie. À propos d’un cas

Hydatid echinococcosis is preferentially localized in the liver. Muscular localization of hydatid cyst is an uncommon event. Symptoms are often discrete. Diagnosis is confirmed by the imaging: ultrasonography and/or magnetic resonance imaging, thus avoiding any untimely gesture. The treatment is surgical. The authors report a case of primary and isolated localization of a muscular hydatid cyst of the thigh in a sport woman revealed by cruralgia.     

Calcification post-traumatique du muscle ilio-psoas. À propos d’un cas et revue de la littérature

Post-traumatic iliopsoas calcifications are extremely rare affections. We report the case of a patient who presented a right hip discomfort after a wakeboard accident. A thick calcification of the right iliopsoas was visible on standard X-rays. Surgery was performed by the removal of the calcification associated to a non-steroidal anti-inflammatory treatment. The result after six months was excellent. The patient has resumed his sports activities at the same level without discomfort and no recurrence of the ossification.     

Instabilité méniscale par subluxation récurrente de la corne postérieure du ménisque latéral

A young football player presented several episodes of locking knee associated with pain of the lateral compartment while MRI was considered normal. The occurrence of an irreducible blocking requires performing arthroscopy with evidence of instability of the posterior horn of the lateral meniscus. After reviewing the literature, it appears that popliteomeniscal fasciculi play an important role in maintaining the stability of the posterior horn of the lateral meniscus. Disruption of these structures, either by default or rupture leads to hypermobility of the lateral meniscus. Clinical examination is not contributory; at most, one finds a pain when tensioning the posterolateral compartment at the “Figure-4 Test” and hypermobility in internal rotation of the knee. The popliteomeniscal fasciculi can be viewed on the “classic” MRI of the knee. We need to know the search during an episode of locking knee without meniscal lesion. The management is surgical with the aim of preserving the meniscus.     

Prise en charge des fractures récentes de la clavicule

Fractures of the clavicle are extremely frequent (2,6 to 5% of all the fractures). They typically occur in male children or young adults before 25 years. Because of anatomical particularity of the bone, these fractures are involving the middle third of the bone in 69% to 82% of cases. Satisfactory results are often achieved with an orthopedic treatment. However, in some cases, increasing risks of poor functional outcomes, higher risk of pseudarthrosis, ungraceful results or delayed work resumption lead to choose a surgical treatment. Many surgical procedures are described by authors to treat these fractures, but actually, there is no common consensus for surgical indication. The admitted shortening value for a surgical treatment is 20 mm. However, Altamini has shown the superiority of a surgical treatment in terms of functional results and decreasing cases of nonunion and pseudarthrosis in cases of fractures involving the middle third part of the bone.     

Traitement des luxations récentes du coude : à propos de 30 cas

Elbow dislocations are encountered in contact sports and other extreme sports. This retrospective study included 30 cases of elbow dislocations, treated between 2007 and 2012. The average age of our patients was 36 years, all male and victims of violent trauma in local equestrian competitions. The dislocation was posterolateral in 23 cases and direct posterior in the other seven. This involvement was associated to a fracture of the radial head in six cases and a medial epicondyle tear in a patient. All subjects had a reduction under sedation or general anesthesia. Fractures of the radial head were treated by screwing in four cases and resection in two cases. We also made screwing for the epicondyle fracture. The treatment was completed by analgesic immobilization for about 10 days followed by active mobilization in 22 patients, in whom the elbow was considered perfectly stable. In eight patients, mobilization in the area of stability, protected by an articulated orthosis, was established for a minimum of 45 days. After a mean follow-up of 22 months, a range of motion for flexion-extension greater than 100° was achieved in 80% of patients and only two cases have kept a severe stiffness. The overall results, as assessed using the Mayo Elbow Performance Score, were good to very good in 25 patients, fair in three patients and poor in only two cases. The sport recovery was gradual and the return to competition was not allowed before the sixth month.     

Tuméfaction de la face dorsale du poignet révélant un muscle manieux

The authors report a case of bilateral extensor digitorum brevis manus muscle, hypertrophied on the dominant side in a young and sportsman patient. The diagnosis was established by magnetic resonance imaging and ultrasonography. Treatment abstention was decided.     

Gluteal Burns from a Car Seat Heater in a Neurologically Intact Patient: A Case Report

BackgroundCar seat heaters are an increasingly common amenity in vehicles in the United States, but they have been shown to place neurologically impaired patients at risk for significant burns.Case ReportWe discuss the case of a neurologically intact and otherwise healthy 49-year-old man who presented to the Emergency Department with second-degree gluteal and posterior upper thigh burns after using a car seat warmer for 8 consecutive hours. At no point during the course of his drive did he experience discomfort beyond feeling slightly warm. The patient was treated with supportive therapy and standard wound care, and he had a full recovery after 10 days. We review the pathophysiology of burns and discuss how seat heaters can place even neurologically intact patients at risk for significant burn injuries.Why Should an Emergency Physician Be Aware of This?Our case is the first published report of a neurologically intact patient sustaining significant burns from the use of a car seat heater. This case illustrates that burn injuries can develop after prolonged exposure even at low temperatures. Emergency physicians should perform a careful skin examination on all patients presenting with gluteal discomfort in whom a history of car seat warmer use is obtained.     

Rôle de l’équipe paramédicale dans la réalisation du contrôle ciblé de la température après un arrêt cardiaque récupéré

Therapeutic hypothermia, also called targeted temperature management, is increasingly used in the intensive care unit (ICU), based on its assessed neuroprotective effects against ischemia-reperfusion-induced brain damage. Targeted temperature management is indicated in comatose adult patients after cardiac arrest if successfully resuscitated from a witnessed out-of-hospital cardiac arrest of presumed cardiac cause with an initial rhythm of ventricular fibrillation or non-perfusing ventricular tachycardia and in a stable hemodynamic condition. Patients after in-hospital cardiac arrest or with other initial rhythms may also benefit. When indicated, therapeutic hypothermia should be quickly performed and tightly controlled. Both surface and core cooling methods target a body temperature of 32 to 34 °C. Thus, it is mandatory to know how to simply manage the routinely available techniques in order to perform hypopthermia as soon as possible, being aware of all side-effects that may alter the expected benefits. Therefore, implementing hypothermia in the ICU involve the whole medical and paramedical staff.     

Apport de l’exercice physique et du régime dans la prise en charge de la gonarthrose chez l’obèse

Objective

Our objective was to determine whether exercise and weight loss are more effective either separately or in combination, in improving pain and physical function in obese adults with moderate knee osteoarthritis (OA).

Patients and methods

Forty-five obese adults, with a body mass index greater than 35 kg/m² or 30 ≤ BMI < 35 associated to at least one cardiovascular risk factor, suffering from knee pain with evident radiographic signs of knee OA, were involved in our study. All patients were evaluated at baseline and at the end of the study. The assessment parameters were weight loss, the bioelectric impedance analysis, pain, six-minute walk distance, cardiovascular parameters, and muscular strength. The physical function was measured with the Womac and the Lequesne indexes. Patients were randomized into four groups, a control group (G1), exercise only group (G2), diet plus exercise group (G3) and diet only group (G4).

Results

There was no difference between the four groups at baseline. Significant improvement of function (Womac) was noticed in groups performing exercise only (G2) (26 %), diet plus exercise (G3) (37,89 %) and diet only (G4) (18,34 %). We also noticed an improvement in pain in G2 (p = 0.04), G3 (p < 0.001) and G4 (p = 0.02). The improvement of quadriceps strength was noted only in G2 (p = 0.01) et G3 (p = 0.001) without any change in control group and diet only group (G4). The improvement of cardiovascular parameters was observed only in G2 and G3. Weight loss, decreased BMI and waist circumference was more important in diet plus exercise group (G3).

Conclusion

The combination of weight loss and exercise provide better improvements in physical function and pain in obese adults with knee OA compared with either intervention alone. Exercise used alone or associated to dietary provides better improvements in physical capacity and muscle strength.     

Place et modalités de la sédation au cours de la ventilation non invasive

One major key of success of non-invasive ventilation (NIV) is the patient’s comfort. Despite the optimization of interfaces, settings, and ventilatory parameters, some patients have to be intubated because of low NIV tolerance. Adapted sedation can overcome this difficulty, aiming to reduce intubation incidence. Even if the use of sedative agents is frequently reported in the literature, only a few prospective studies have tested sedation protocols adapted to this situation. Administration of drugs with rapid onset and short duration of action, using target-controlled infusion should avoid NIV failure due to patient’s intolerance. Sedation objective is not to delay intubation but rather to allow NIV continuation in case of intolerance or major discomfort.     

Avulsion post-traumatique de la tubérosité ischiatique chez le sportif

The avulsion fractures of the ischium are rare lesions, which are often unnoticed. When they are not diagnosed and, consequently, not dealt with, they are at the origin of persistent pains and could stop the sports activity. We report the case of an avulsion–fracture ischiatic tuberosity in a 16-year-old sportsman patient. The diagnosis selected initially was a tendinitis of hamstring and a medicamentous treatment was given. The symptomatology did not regress and the patient was entrusted to us at the end of six months. The take-in-charge consisted of reduction and the osteosynthesis of the detached fragment with simple postoperative and retake of sports activeness after one year.     

Intérêt de l’arthroscopie du genou dans le traitement du syndrome de la bandelette iliotibiale

Iliotibial band syndrome is a common cause of lateral knee pain in athletes. The diagnosis is clinical. Surgery can be proposed if well-conducted conservative treatment is unsuccessful for 6 months. We reviewed a retrospective series of seven patients at mean 3.7 years postoperative follow-up. Six practiced sports regularly. The preoperative work-up included a physical examination, standard X-rays and MRI of the knee joint and arthroscopy for all patients. Open surgery was performed with transverse section of the posterior fibers (10 mm). The outcome assessment was based on the pain score, the subjective IKDC score, and resumption of sports activities. Six patients had intra-articular lesions, which for three patients had been missed preoperatively. Arthroscopy was performed for complementary treatments in four patients. In 2008, six patients responded to a telephone interview. Outcome was very satisfactory: mean IKDC score was 84 in five patients who had resumed their sports activities at the same level. One patient underwent arthroscopy to rule out any intra-articular lesion causing lateral pain. Possible intercurrent conditions could be the cause of persistent pain despite adequate medical treatment and physiotherapy. Certain authors propose arthroscopic release. This option enables complementary treatments in the same operative time.     

Lombalgie chronique et réentraînement à l’effort : application de la notion de niveau de douleur cliniquement acceptable

Objectives

To search for predictors of reduced low back pain under the patient acceptable symptom state (PASS) at the end of a functional restoration program (FRP) in chronic low back pain, and then to compare the effectiveness of FRP depending on the rate of people returning to work, the acceptability threshold of pain has been reached or not at the end of the program.

Method

Open prospective study on 303 patients with chronic low back pain included in a FRP. An assessment of the deficiencies (finger-tip-to-floor (cm) and Schöber tests (cm), VO2 max (l/min), Shirado and Sorensen tests (seconds), lumbar and radicular VAS (0-100), the functional disability (Wadell and Quebec scales (0-9 and 0-100), and the psychological status (Beck and Hamilton scale (0-35 and 0-30), HAD scale (0-21), FABQ (0-42 and 0-24)) was conducted at the beginning and end of the program. Data on the work were also collected (arduous physical labor, work-related accident or not, sick leaves or not and length, return to work at the end of the program). The variables associated with a PASS at the end of the FRP and a correlation between the level of pain and the return to work were sought.

Results

The parameters were significantly improved : finger-tip-to-floor test (−17,5 ± 16,2), Schöber test (−0,5 ± 5,4), lumbar VAS(−6,3 ± 23,6), VO2 max (0,14 ± 0,4), Wadell (−1,3 ± 2,4), Quebec (−10,5 ± 17), Beck D (−3,1 ± 4,5), Beck A (−2,5 ± 4,3), HAD D (−2,4 ± 4,7), HAD A (−1,3 ± 3,8) et FABQ1 (−5,7 ± 11,6), FABQ2 (−3,9 ± 9,6) scores, endurance of the flexor (35 ± 63,83) and extensor (44,8 ± 112) spine. Patients reaching the PASS for pain level return significantly more to work (73% versus 52%). Five parameters indicative of a reduction of back pain under the PASS were identified : lumbar VAS and endurance of the flexor spine at the beginning, changes in finger-tip-to-floor test, radicular VAS and Beck score for anxiety.

Conclusion

The PASS appears to be a relevant concept associated with a successful return to work for patients with chronic low back pain and severe disability after a program of FRP.     

Fracture ouverte de la clavicule et traitement par fixateur externe. À propos d’un cas et revue de la littérature

Introduction

Clavicular fractures are treated by orthopedic means or by surgery with internal fixation. Most open fractures are also treated surgically but the use of external fixator remains exceptional.

Clinical case

It is about a 23-year-old patient presenting secondary punctiform cutaneous opening within the framework of clavicule fracture. The fracture had remained exposed for more than 24 hours. After trimming of the wound and reduction, the stabilization of its fracture was carried out by an external fixator Percy Fx^®. The patient directly began rehabilitation for his upper limb. No infection was noted. On the third month, the callous was solid enough to allow hardware removal simple sedation.

Discussion

The cutaneous opening of the clavicule fractures is rare and represents less than one case over 1000. The open fractures in polytrauma patients are accompanied by other direct vascular, nervous even pulmonary complications. In the case of open fracture, surgery is indicated either by intramedullary nailing or with plate and screw fixation. However, the use of an external fixator is recommended by certain authors. The stabilization of this fracture was carried out by an external fixator whose flexibility, light character and radiotransparency, facilitated the follow up.

Conclusion

Although the installation of an external fixator remains exceptional for the treatment of an open clavicule fracture, this method could be under certain conditions an alternative technique to osteosynthesis.     

La posture et le contrôle postural du patient cérébrolésé vasculaire: une revue de la littérature

After a stroke, the recovery of balance may be considered a critical component of the motor behavior for achieving autonomy in activity of daily living. The balance deficiency encountered by hemiplegic patients has been extensively reviewed in this paper, from both clinical and scientific points of view. Postural control is organized to build up and update the body orientation (posture) and ensure that balance is maintained. This complex function is based on four components [82]: reference frames for organizing posture and/or movement toward given target, multisensory inputs regulating orientation and stabilization of body segments, postural reactions or anticipations for balance recovery after disturbance, postural stabilization during voluntary movements. In the light of recent works concerning hemiplegic patients, some characteristics are emerging in each of these four fields. In the present paper, special attention was given to head and trunk orientation, sitting posture, dynamic equilibrium, and retraining balance and recoverey after a cerebrovascular accident. The authors have made an attempt to clarify the causes of balance impairment in hemiplegic patients, based on the new trends in the topic.     

Complicaciones de la nutrición parenteral periférica. Observación clínica de 2 casos

IntroductionPeripheral parenteral nutrition (PPN) is artificial nutrition used when digestive absorption is insufficient. It supplies the nutritional needs of the patient and permits administration through a peripheral catheter.We present 2 clinical cases.The first one entails an epidermolisis through extravasation masked by temporo-spatial disorientation of the patient with appearance of flictenes (blisters). Prolonged treatment and consultation with plastic surgery were required.The second case entails a chemical phlebitis with early detection by nursing professionals. It was resolved with short term treatment and did not require consultation with the plastic surgeon.Planning careWe elaborated a care plan aimed at identifying real or potential problems related with possible complications of intravenous PPN administration, such as phlebitis and extravasation. The aim of this research was prevention, early detection and treatment.DiscussionPhlebitis is related with catheter characteristics, in-dwelling time and high osmolarity of PPN.Early action decreases injury of the affected tissue. In case 1, the patient requires 19 days of curing. This was only 72 h in case 2.ConclusionThe nursing staff plays an essential role in catheter election, localization, administration and preventing complications. Staff training and a procedure protocol greatly reduce the incidence of phlebitis, avoid discomfort for the patient and reduce health care cost.     

Histoire naturelle de la marche et de la posture chez l'Homme. Partie 2. Hanche et cuisse

The human fossil record is one of the most complete for many mammal. A basal ancestral species, Australopithecus afarensis, exhibits a well-preserved postcranium that permits reconstruction of important events in the evolution of our locomotor skeleton. When compared to those of living apes and humans, it provides insights into the origin and design of the modern human frame. Evolutionary aspects of the human hip and thigh are reviewed, including the unsusual corticotrabecular structure of the human proximal femur, and our markedly elongated lower limb. It is postulated that the latter may be more related to birthing capacity than to locomotion.     

Arterial injury from a high pressure water jet: case report

We report the case of a patient who sustained a high-pressure water jet injury to the thigh while cleaning industrial piping. The patient presented with a puncture wound to the anterior thigh and a pulseless foot. Emergency arteriography was performed that revealed complete disruption of the superficial femoral artery. The patient underwent surgical exploration and debridement, and a successful repair of the disrupted artery was performed with a prosthetic arterial graft. A discussion of high-pressure water jet injuries and their management is presented.     

Obturator hernia: a difficult diagnosis

We have presented the case of an elderly woman with severe kyphoscoliosis, osteoarthritis and left knee effusion who had symptoms and signs of intermittent intestinal obstruction. Operation showed a left-sided obturator hernia. In any elderly, debilitated, chronically ill woman, symptoms and signs of recurrent small-bowel obstruction (without a history of abdominal surgery or external hernias) and pain along the ipsilateral thigh and knee (Howship-Romberg sign) should raise suspicion for an obturator hernia. If the hernia is not palpable by physical examination, a CT scan of the pelvis and upper aspect of the thigh would confirm the diagnosis before operation and allow prompt treatment and better chance of patient survival.