Force isocinétique des muscles rotateurs de l’épaule dans l’instabilité chronique antérieure

Given the role of dynamic stabilization means in shoulder recurrent anterior instability, due to the failure of passive stabilization means, a better understanding of the role of internal (IR) and external (ER) rotators muscle strength, and their agonist/antagonist balance, could be of interest in the therapeutic arsenal around this disease. In the light of the literature, a deficit of IR and ER muscle strength seems associated with unoperated recurrent anterior instability. After surgical stabilization using the Bristow-Latarjet procedure, there appears a transitional post-surgical deficit of the IR and ER muscle strength compared to preoperative values during 3 to 6 months post-surgery, but the preoperative deficit compared to contralateral shoulder seems to persist despite the surgical procedure and the postoperative rehabilitation care. Evaluation of IR and ER isokinetic muscle strength is relevant in monitoring patients with shoulder recurrent anterior instability, unoperated and post-surgery, in order to determine the orientation of rehabilitation, to help the decision for continuing or not strength rehabilitation, and to help the decision when deciding upon an appropriate time for return to sports.     

Les instabilités antérieures de l’épaule. Á propos de 50 cas

We performed 54 consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1996 and 2005. We retrospectively reviewed the clinical and radiographic results of the procedure. The procedure was performed for the treatment of recurrent anterior dislocation in 51 shoulders, painful recurrent anterior subluxation in two cases and painful shoulder in one case. All patients had a radiographic evaluation before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation. According to the system of Rowe, 51 (94 %) of the 54 shoulders had an excellent or good result. Fifty-one shoulders had no glenohumeral osteoarthrosis.     

Instabilité d’épaule et isocinétisme : apport de l’isocinétisme dans une situation clinique complexe

Introduction

The treatment of shoulder instability is codified. In case of a resistant instability to a well-conducted rehabilitation, the surgery can be proposed with good results. Sometimes, the situation can be more complex, and the case report presents the interest of isokinetics as an alternative therapeutic.

Case report

A man of 36 years, operated of Latarjet for recurrent anterior dislocation of the shoulder, presented in postoperation an infectious osteoarthritis. After recovery of the infectious episode, in a painful and stiffness shoulder, shoulder instability repeated with a clinical examination agreeing and an evocative context: failure of the surgical treatment, osseous postinfectious rehandlings. The surgery having been excluded and traditional rehabilitation having shown its limits. A rehabilitation oriented by the research of a muscular imbalance in isokinetic evaluation permitted a functional improvement with disappearance of the instability feeling.

Discussion

In complex clinical situations, isokinetic evaluation showed an interest to adapt and to optimize rehabilitation. A practical application of isokinetics is in the pathologies of articular instability and in particular the shoulder instability. The positions of evaluation will be adapted to the patients. That opens new prospects in rehabilitation.

Conclusion

This case report illustrates isokinetic interest for an objective and rigorous assessment of muscular strength and so an adaptation and optimization of the rehabilitation.     

Influence du type d’orthèse de genou sur l’évolution clinique postopératoire d’une chirurgie du ligament croisé antérieur chez le sportif

Objectives

To establish the influence of the type of brace on the postoperative clinical evolution after anterior cruciate ligament (ACL) surgery in competitive sportspeople.

Methods

The authors prospectively followed the evolution of three populations of ACL reconstruction: one who received a functional brace, the other a rigid brace and last no brace. The three groups followed the same rehabilitation program. The clinical parameters of evaluation were pain, perimeter patellar joint, range of motion, muscular atrophy, locking the quadriceps, and the quality of walking. We also used the IKDC subjective Knee Evaluation Form and PPLP scoring scale.

Results

There is no clinically significant difference at about a month of surgery between the three groups (407 patients). There is no difference with the PPLP scoring scale. No repeat rupture is occurred postoperatively. There is a significant difference in the IKDC subjective (P = 0.03) between the group with functional brace and rigid brace.

Conclusion

With the same active rehabilitation program, the clinical evolution is identical with or without brace. The only difference is subjective (IKDC subjective Knee Evaluation Form).     

Fracture-avulsion de l’épine iliaque antéro-inférieure et du petit trochanter chez un jeune adolescent

The avulsion fractures of the anterior-inferior iliac spine and lesser trochanter are rare. They occur most often in adolescents during sports activities. The forms in adults are rare. We report a case in a young 15-year-old teenager. He had consulted for pelvic trauma with groin pain and functional impotence of the right lower limb occurred during a recent game in triple jump. Physical examination revealed pain in the mobilization of the right hip in extension. Standard radiography of the pelvis has highlighted an avulsion fracture of the anterior-inferior iliac spine avulsion of the right with small trochanter, which has been confirmed by computed tomography. The patient has been treated orthopedically by rest and landfilling lower limb trauma, evolution was marked the disappearance of pain a few weeks later and resumption of the sporting activity in order to 6 months.     

Luxation antérieure de l’épaule associée à une fracture de la diaphyse humérale homolatérale (à propos d’un cas)

The association of shoulder dislocation with ipsilateral humeral shaft fracture remains rare. Is presented along with a review of the literature regarding 18 reported cases. The prognosis depends on that of the shoulder. The authors report a case of shoulder dislocation with ipsilateral humeral shaft fracture at a patient of 34 years an accident of sport (cyclocross). After closed reduction of the anterior shoulder dislocation. The treatment was surgical, required open reduction of the humeral fracture with compression plating. At recession of one year, the clinical examination finds amplitudes comparable to the shoulder controlatéral without instability.     

Ligamentoplastie du LCA aux ischiojambiers sous arthroscopie avec fixation de l’implant par le système TLS. Principes et résultats de 38 cas

The rupture of anterior cruciate ligament (ACL) is the most frequent in modern sport. Our team has adopted a new technique of ACL reconstruction using a single hamstring tendon fixation with a tape locking screw (TLS), which saves bone and tendon, for a possible long-term recovery. The experience of our team in terms of ligament reconstruction is very satisfactory functional results, allowing us to assert that the ligament reconstruction using the TLS technique is a reliable surgical technique, reproducible and not iatrogenic, with low morbidity and rapid functional recovery compatible with the requirements of modern sports.     

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.     

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.     

La fracture de Tillaux chez l’enfant et l’adolescent. À propos d’une série de 11 cas

Background

Tillaux fracture in child correspond to Salter and Harris type III fracture involving the anterolateral portion of the distal tibial epiphysis. These are intra-articular fracture. The aim of this study was to analyze the therapeutic modalities and long-term clinical and radiological outcome.

Patients and methods

We reviewed retrospectively 11 Tillaux fractures. All underwent surgical treatment.

Results

The average age was 13.5 years. Patients were treated by open reduction and screw fixation. At mean follow-up of 28 months, results were rated well in nine of 11 cases.

Conclusion

The prognosis of Tillaux fracture in child is good as was observed in our studies and in series reported in the literature.     

Fixation des reconstructions du ligament croisé antérieur aux ischiojambiers par un « crosspin » unique (étude biomécanique)

Introduction

Postoperative reeducation and the retaking of precocious activities after the reconstruction of the anterior cruciate ligament (ACL) require a primary fixation to the adequate mechanic characteristics. The aim of the study is to determine the fixation properties with a unique RigidFix^® crosspin of the tendinous transplants in tiny diameter tunnels simulating a double bundle reconstruction.

Material and methods

On six adult fresh frozen cadavers (12 femurs and 12 tibias dissected), 48 bone tunnels were prepared in which were fixed with a single “crosspin” RigidFix^® a tendon with adequate diameter to tunnels (5, 6, 7 and 8 mm). Two types of tests were performed: cyclic test (sinusoidal load between 50 N and 150 N for 500 cycles) and ultimate load test (increasing load with a controlled speed 5 mm/min).

Results

The mean lengthening after 500 cycles was 1,89 ± 0,84 mm. The yield load was 262 ± 60 N with a lengthening of 4,61 ± 1,68 mm. The stiffness of the whole mounting was 61 ± 16 N/mm and the max load is 295 ± 79 N. The resistances (yield load and max load) were more important in the femur than in the tibia.

Discussion

The stress supported by the femoral fixation is less important than the tibia, in view of the application angle when the knee is extended. The yield load result fulfilled the specifications in the femur. At the tibia, the ultimate strength is not enough to allow intensive rehabilitation.

Conclusion

The use of a single “crosspin” in an anatomic reconstruction of anterior cruciate ligament is possible at the femur with diameters of the transplant greater than or equal to 6 mm, but not desirable in the tibia.     

Limitation et arrêt des traitements en réanimation : comment évaluer et améliorer nos pratiques

Witholding and withdrawing of life support is a daily question for intensive care unit physicians. Accordingly with recent French laws, theses procedures must be formalized and organized in each intensive Care Unit. In order to allow local organisation and procedures evaluation, three documents have been made available by the Ethic Committee of the Société de réanimation de langue française. These documents called évaluation des pratiques professionnelles are presented herein (also available on: http://www.srlf.org/Data/ModuleGestionDeContenu/application/848.pdf) and may be utilized for retrospective and prospective evaluation of the witholding and withdrawing of life support procedures.     

Faux anévrisme de l’artère sous-clavière compliquant une fracture de la clavicule

The post-traumatic false anevrisms of the subclavian artery are rare; they exceptionally occur in a context of sports injury. They are, in most cases, the consequence of an artery pinning due to fractured clavicle. Both painful mass and traumatic history make the clinical diagnosis easier. The ischemic signs are rare and neurological ones reflect a brachial plexus injury. Doppler ultrasound and angiography have facilitated the procedures of diagnosis and contribute to the choice of the surgical approach and surgical tactics. Angiography as a diagnosis investigation is almost abandoned, but it triumphed among the ways of management once endovascular treatment is considered. Surgery remains the treatment of choice; it includes the flattening of the false aneurism, a restoration of arterial continuity and stabilization of clavicular fracture in the same operation. We report the case of a 30-year-old young man who, after a sport accident, had a fracture of the right clavicle with a false aneurism of the subclavian artery discovered 3 days after the trauma. He had received a flattening of the false aneurism and internal fixation with a clavicular bone plate with a favorable outcome. In this work, we remind the circumstances of occurrence, diagnostic and management therapeutic features of these rare lesions.     

Nutrition artificielle en fin de vie : aspects éthiques

Current practice of nutrition support in the end-of-life critically ill patients is heterogeneous and namely influenced by ethical, cultural and religious factors. The translation of the ethical principles of beneficiency, non-maleficiency, autonomy and justice regarding the management of nutrition therapy are rarely evoked and largely varies between countries. This article will review these disparities and will try to discuss the potential causes.     

Fractures simultanées de la base et du col du cinquième métacarpien. À propos d’une association lésionnelle rare

We report the case of a rare combination of a fracture-dislocation of the base and a neck fracture of the 5th metacarpal, the mechanism was direct, result of a punch in a young sportsman. We made a closed reduction of both fractures with a pinning of the neck of the fifth metacarpal in L according to Vives, and intermetacarpal plinning of the base. Evolution over 12 months was satisfactory.     

Communication aux ayants droit du dossier du malade décédé

The Act of March 4, 2002 allowed the transmission of medical information concerning a deceased person to his heirs in three situations. The insurance companies, on the basis of this section of the Code of public health, require systematic transmission of the minutes of hospitalization (CRH). What should be done on the basis of rules governing professional secrecy and (on the basis) of jurisprudence in this area? As the professional confidentiality constitutes a legitimate interest, it is possible in some cases to refuse the transmission of CRH by writing a detailed/circumstantial medical certificate.     

Traitement chirurgical du pied varus équin spastique par transferts et allongements tendineux Étude rétrospective de 65 pieds opérés

The authors evaluate the efficiency of the surgical technique of split anterior tibialis transfer, describe the long-term functional results of the operation, and discuss the indications of this method of treatment. The results were very satisfactory: after surgery, 51 of 56 patients had normal shoes, 48 patients had improvement of their level of autonomy. The morbidity was very low, no patient had aggravation of the neurologic disease or general complications. The authors conclude that this operation should be employed more frequently in these disabled patients who can find definite improvement.     

La personne de confiance

The French law of March 2002 allows the hospitalised patient to designate a trusted person who can support, help and represent him throughout his disease's curse. This role has been strengthened by the law of April 2005. This article aims to explain the mission of the trusted person and discuss the limitations of such designation.     

Le réentraînement proprioceptif chez les patients opérés d’une ligamentoplastie du LCA : quels effets sur le contrôle de l’équilibre ?

In order to show the effects of proprioceptive rehabilitation on postural control, 14 patients with postoperative anterior cruciate ligament reconstruction have been tested according to one-leg and two-leg standing tasks. Patients have been tested before and after the proprioceptive protocol on a force platform for three trials lasting 32 seconds, without shoes, eyes open. They were required to stay motionless as much as possible during the test. The data were then analyzed through classical parameters including mean positions, surface, variances and mean velocity of the center of pressure displacements and modeled as fractional Brownian motion (fBm). No statistically significant effect was observed during one-leg standing, whereas significant effects were reported during two-leg standing. More precisely, the strategies used to limit the antero-posterior body motions are changed and the asymmetries between the two legs, initially observed, tended to disappear. Thus, the proprioceptive rehabilitation protocol interferes with postural control, but in different ways according to the condition. Two-leg standing appears therefore as a more objective way to assess the proprioceptive rehabilitation effects and its measure may be used as benchmarks during rehabilitation.