Les troubles mictionnels chez les sujets porteurs de séquelles de lésions périnatales sans handicap intellectuel

Micturition disorders in cerebral palsy without intellectual deficit. Sixty-three patients with cerebral palsy and micturition disorders were investigated. The age ranged between 5.5 and 38 years (mean 13.5). Half had diplegia, one-third had quadriplegia and were dependant. Incontinence was the most common sympton (dysuria was noted in half cases), mainly in quadriplegic, dependant patients. The urodynamic assessment confirmed the dysfunction and showed hyperreflectivity with or without asynergy. However, no therapeutic approach has been validated.     

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.     

Luxation traumatique bilatérale de la hanche

Bilateral traumatic dislocation of the hip joint is very rare but not new; Marquardt in 1936 reported the first case; only 51 cases have been reported so far. Here is another case with over a 1-year follow-up period.     

Revue de la littérature des différentes techniques de réduction de la luxation glénohumérale antéro-interne,employées de l’Antiquité à nos jours

The glenohumeral joint is the most mobile articulation of the human body. Its anatomy makes it particularly vulnerable. Anteromedial dislocation is a very common traumatic event. Since antiquity, many methods for reduction have been described, all are far from obsolete. Many can still be used today. Is there an ideal method?     

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.     

Hernie musculaire postérieure de la cuisse réparée par plaque non résorbable. À propos d’un cas et revue de la littérature

Muscle hernias in the hamstring (semitendinosus, semimembranosus and biceps femoris) area of the thigh are rarely described in the literature. We report a case of an athletic patient, an avid cyclist, who presented a daily discomfort in the posterior region of the left thigh with irradiation to the knee and it became intensive in one year. A soft reducible non-painful superficial mass could be palpated. Ultrasonography reveals the herniation of fatty tissue through the superior superficial fascia of the thigh at the base of the posterior cutaneous nerve. Since primary repair of the fascial dehiscence was not possible, the surgery was performed by implanting a non-degradable surgical mesh, routinely used to treat inguinal hernias. The results after 24 months of follow-up are highly satisfactory: the patient has been able to return to all his daily and sports activities without discomfort or recurrence of the hernia.     

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.     

Suture percutanée des ruptures fraîches du tendon calcanéen: À propos de 60 cas

A prospective study of 60 cases of percutaneous suture for Achille tendon rupture were done from January 2001 to September 2006. Twenty-eight patients practiced sport, three with high competitor level. Mean follow-up was 13 months (6–58). Eighty-nine percent patients return to sport activities at mean 5.2 months (3–12) at the same level in 68%. Return to work was mean 85 days (15–270).     

Distribution de deux peptides de l'acide γ-aminobutyrique dans le liquide céphalo-rachidien et le cerveau humains

The distribution of two peptides of γ-aminobutyric acid, homocarnosine and α-(γ-aminobutyryl)-lysine, was studied in human brain and cerebrospinal fluid. Adult brain and cerebrospinal fluid α- (γ-aminobutyryl) -lysine levels and adult brain homocarnosine levels are higher than those found in children. On the other hand, it is known that the cerebrospinal fluid from children contains higher concentrations of homocarnosine than those observed in adults.     

Tolérance locale et cardiovasculaire d'une séance de stimulation électrique des muscles des membres inférieurs chez les patients insuffisants cardiaques

Objective: to evaluate the haemodynamic and clinical tolerance of a session of low frequency electrical stimulation of inferior limbs muscles in patients with congestive heart failure. Patients and méthods: fifteen patients with congestive heart failure were treated with a one-hour session of electrical stimulation of quadriceps and calf muscles (10 Hz frequency, maximal amplitude tolerated, alternative 20 seconds on and off). The cardiac output, the heart rate, the blood pressure and the blood velocity in the femoral artery were evaluated at baseline and during stimulation. The cardiac rythm was evaluated using a 24-hour holter recording. A subjective evaluation of the quality of the induced contractions was performed. Results: electrical stimulation did not induce changes in cardiac output and rythem, in heart rate and in blood pressure. The electrical-induced contractions were of good quality in 11 patients. The mean blood velocity in femoral artery increased during stimulation (37.6% after 20 minutes, 39.6% after 35 minutes, and 41.6% after 50 minutes). Conclusion: a one-hour session of electrical stimulation of quadriceps and calf muscles with stimulation amplitudes sufficient to obtain good-quality contraction and an increase in femoral artery blood velocity does not induce rythmic or haemodynamics variations in patients with congestive heart failure.     

Rééducation accélérée après ligamentoplastie par la technique DIDT par un protocole simple et adapté à chacun

With most procedures of rehabilitation following reconstruction of the anterior cruciate ligament that was treated though the technique of ligamentoplasty using gracilis and semi-tendinous, the hamstring can’t resume activity until four to six weeks after the operation. Comparing the engraftment of post-traumatic muscle damage, the described rehabilitation procedure is an accelerated procedure that uses early eccentric strengthening of the hamstring starting on day 8. This is achieved first by manual resistance until day 21 then on a hamstring chair from day 21 to day 45. The aim of such a treatment is not to resume sporting activity more quickly, but to ensure that the conditions for recovery are optimized. The described treatment also presents some limitations and should therefore be applied with caution so as not to jeopardize the ultimate recovery of the ligament.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

Étude épidémiologique prospective des pathologies dans le XV de France féminin de rugby de juillet 2006 à septembre 2010

The objective of this prospective study is to determine the rate of injury on the population of the French women's rugby team. It was conducted over 50 months from July 2006 to September 2010. The medical staff of the French team collected data during training and match exposure. One of the main results of the study is the significant difference in the incidence of injury leading to a sports interruption greater than 8 days between female and male (5.99/1000 hours vs. 42,1/1000 hours). Lower limb injuries represent half of the injuries observed in our study but the articular lesions represent 80.43% of the injuries leading to an interruption superior to 8 days with an incidence of 4.62/1000 hours of exposure per position. This confirms the data found in the medical literature. The ruptures of the anterior cruciate ligament, following a tackle, are the most severe lesions of our study. The forwards had a higher rate of injury than backs. The three positions most exposed to injuries are the nos. 8, 9 and 14. The players are most vulnerable when they are being tackled, during the runs and during the rucks. The study described significant differences concerning a much higher number of severe articular lesions, a more significant vulnerability of women in sustained tackles in a match situation and a different exposure of certain position, particularly the scrum-half and the right-wing.     

Avulsion de la tubérosité ischiatique chez l’adolescent : à propos de deux cas cliniques

Ischial avulsion, often diagnosed as a musculotendinous injury, is a traumatic pathology related to physical activity. Treatment of ischial avulsion fractures is not consensual. The authors present two case reports of adolescent football players with an ischial tuberosity avulsion submitted to a conservative rehabilitation programme, with different outcomes. One of the patients returned to competition but the other gave up football due to pain. In these case reports diagnosis, treatment and follow-up results are discussed.     

Le traitement des fractures comminutives de l’extrémité distale du radius par fixateur externe : à propos de 18 cas

Comminuted fractures of the distal radius are common. A retrospective study was conducted in the department of orthopaedic trauma-A of university hospital Hassan II of Fez on a six-year period between January 2005 and December 2010 involving 18 cases of comminuted fractures of the distal radius treated with distraction external fixator. The average age of our patients was 28 years old, all male, all of our patients had a wrist injury during a sports accident. The right side was affected in 88 % of cases. X-rays have objectified an articular fractures and/or comminuted without opening the skin, we adopted the Castaing classification stadifier for fractures of the distal radius. The treatment consisted of a bipolar distraction external fixator combined with a plug-in three patients, ablation of osteosynthesis material was carried out in 6 weeks, then physical therapy was started. After falling 21 months, our results were very satisfactory with good recovery of mobility of wrist and back of any sport.     

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.     

Fracture-avulsion négligée de la tubérosité tibiale antérieure

Avulsion-fracture of the tibial tubercle has been well described and its management is now well codified in standard orthopaedic textbooks. Diagnosis is based on clinical features and standard radiology. The authors present a case of a neglected type IIA avulsion-fracture of the tibial tubercle. Surgical treatment gives an excellent outcome despite intra operative difficulties.     

Une estimation des décès traumatiques liés à la pratique sportive en France métropolitaine,en 2010

Introduction

Physical exercise presents numerous health benefits but it can also lead to accidents, of varying degrees of severity, some of which can result in death. The purpose of this study was to estimate, for the year 2010 in metropolitan France, the number of injury-related deaths linked to sporting practices.

Method

The study consisted in counting the injury-related deaths that occurred in 2010 in metropolitan France following a sporting practice, regardless of the context (professional, leisure or travel). Deaths linked to cycling, deaths in airplanes and deaths by drowning were not considered as sporting practices and so were not included in the study. The figures were collected from documentation compiled by government institutions or available in on-line media and the websites of associations and government organizations involved with sport.

Results

In 2010, 246 people died as a result of a sporting activity in metropolitan France. Mountain sports were the most dangerous (99 deaths), followed by water sports (50), hunting (27), aviation sports (23, of which 22 in ultralight/microlight aircraft), mechanical sports (23) and free flight sports (20, of which 10 were linked to paragliding and five to hang gliding). Seven times more men died than women. The most dangerous periods were summer and winter.

Discussion

Our study missed some cases, which led to an overly low figure for certain sports (horse riding and fishing, etc.), and missed those people who did not die immediately following their accident. This simple study, which remains to be completed, has provided an initial estimate of the number of injury-related deaths linked to sporting activities in metropolitan France.