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.     

Avulsion de la tubérosité tibiale antérieure chez un jeune sportif

Avulsion fracture of the anterior tibial tuberosity is rare. This lesion occurs in the sportive adolescent. The authors report a case of 16-year-old sports amateur, who presents an avulsion of the anterior tibial tuberosity, treated by surgery. Epidemiologic, etiopathogenic, therapeutic and pronostic aspects are analysed.     

L’avulsion de la tubérosité tibiale antérieure chez l’adulte

The authors report two cases of patients operated for avulsion fracture of the tibial tubercle. The traumatisms occurred during sports activities (karate, basketball). The treatment consisted in open reduction of the tibial tubercle then fixing it by screwing. At the end, after rehabilitation, the functional results were good.     

La fracture de Tillaux chez l’adulte (à propos de deux cas)

The authors report two observations of fracture of Tillaux in two adults. The treatment was surgical at a patient and orthopedic at the other. The functional result was satisfactory.     

Lésions méniscales isolées chez le sportif. À propos de 120 cas

Meniscal lesion is a frequent affection in sport practice and which can affect – in mid and long terms – the fonctionnal prognosis of the knee and thus the sport career of the patient. Hence the importance of precocious diagnosis and adequate take-in-charge. We report a series of 120 cases of isolate meniscal lesions (76% internal meniscal lesions and 24% external meniscal lesions) in a sports population treated under arthroscopy and rechecked after a mean relapse of four years. Our results were good to excellent in 82.5% of the cases with retake of sport activity in 90% of our patients of which 60% in the preoperative level. 54% of the cases underwent standard radio control in their last visit. This control was normal in 46% of them, showed a pinching in the internal compartment in 22% of the cases and external in 32% of the cases. As for its reliability, its simplicity and relative innocuteness, the treatment of meniscal lesions under arthroscopy fulfills the requirements imposed by sport population's tasks.     

L’ostéochondrite disséquante du genou chez l’enfant et l’adolescent. Notre expérience à propos de 32 cas

Osteochondritis dissecans (OCD) rarely involves the femoral condyle and affects especially the athletes. Etiology of OCD remains enigmatic. This retrospective study analyzed 32 cases (28 children) stemming from a paediatric series. All the concerned children exercised a sports activity. OCD can be grave on the functional plan and burden the sports future of the child. The clinical symptomatology was poor. The circumstances of discovery were essentially represented by an atypical pain of the knee. The diagnosis was confirmed by a standard radiography revealing a specific hurt of variable aspect, being able to go of a simple suspect line to a big loss of substance at the level of the femoral condyles. The used classifications were the ones of Bedouelle, Cahill, as well as Harding one. Mostly, the pathology was diagnosed at a premature stage I and II of Bedouelle. The examinations of imaging (Magnetic Resonance Imaging [MRI], CT scan) were individually decided to explore the lesion or for a choice of the therapeutics. The stake in simple discharge with a strict stop of the sport gave satisfactory results so clinical as radiological in our study. The surgery was exceptional. The forecast is usually good at the child's subject to an adapted coverage by not allowing passing the hour of the surgery. The sport practised in an excessive, intense way (competitive sport) is recognized as a major risk factor.     

Fracture-avulsion de l’insertion tibiale du ligament croisé postérieur chez un enfant. À propos d’un cas et revue de la littérature

The isolated lesion of the posterior cruciate ligament (PCL) and in particular the tibial avulsion is a rarely reported entity on immature skeleton. We report a case of isolated avulsion fracture of the tibial insertion of PCL in a young athlete of 14 years old, treated surgically with good functional results 2 years later.     

Avulsion traumatique du tendon tricipital brachial : à propos d’un cas

The authors report the rare case of a socker having a complete avulsion of the triceps brachii tendon. The diagnosis was evoked on profil standard radiographs of the elbow. Treatment was surgical by reinsertion of the tendon through olecranon. Follow up at 24 months, the results were satisfactory with total recovery of the function of the triceps and elbow flexion extension perfect.     

Luxation traumatique isolée de la tête radiale chez l’adulte : à propos d’un cas et revue de la littérature

The authors report a case of isolated dislocation of the head radial road at a patient of 34 years following an injury in pronation and extension of the left elbow in a match of handball. After reduction, as a matter of urgency, the patient is immobilized during 15 days by a brachio-ante-brachio palmaire plaster in 100°. At recession of one year, the clinical examination finds amplitudes comparable to the elbow controlatéral. Only 20 cases of dislocations of the head radial road at the adult were reported in 30 years, among which 13 of them were reduced without surgery and without recurrence. The mostly found mechanism is a hyperpronation, the typical clinical case is a complete blocking of the prono supination without important deficit of the flexion extension.     

Luxation traumatique négligée de la tête radiale chez l’adulte (à propos d’un cas et revue de la littérature)

The authors report the case of an isolated dislocation of the head radial road neglected during 2 months at a 28-year-old patient further to a fall on the right hand bends in extension and hyperpronation of the front arm. The treatment consisted of a bloody reduction of the head radial road by extern way of the elbow with one temporary embrochage pen radial road and a suture of the previous annular ligament by point's transosseux paletot with plastered brachio-antébrachiopalmaire fixed asset in 100° of flexion. For to remind the diagnostic and therapeutic difficulties of this pathology, we propose the study of an observation analyzed in the review of the literature.     

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.     

Traitement des ruptures négligées du tendon rotulien (à propos de deux cas)

The authors report two cases of neglected patellar ligament rupture treated surgically. The repair was made by suture of the tendon rotulien strengthened by a fragment of the vast medial associated with a hooping to the son of steel for the first case; and a reconstruction with transplant free bone-tendon-bone taken in depend on the knee controlateral, supported by a centring to the son of steel in 90°de flexion for the second case. No postoperative immobilization is made allowing beginning at once the re-education. The functional result was excellent on the active extension but with a sequellaire steepness concerning the flexion for the first patient. The surgical technique must be individually adapted; the centring of protection must be systematic but realized carefully to avoid the frequent abnormalities of location of the kneecap and the fémoro-patellaires conflicts and authorizing a fast reeducation. Through a review of the literature, we recall difficulties of care of this injury even on the diagnosis and therapeutic levels.     

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.     

La fracture de Hahn-Steinthal chez l’adolescent. Une lésion rare à ne pas méconnaître

The Hahn-Steinthal fracture or type I fracture of the capitellum humeri is an articular lesion with a frontal fracture line. This fracture is uncommon in the pediatric population but can occur in adolescent and adult. The diagnosis is often missed. The avulsed fragment must be identified on good quality lateral X-rays. We present the case of a 13 years old adolescent who sustained a Hahn-Steinthal fracture of the capitellum, occurring at the time of basketball competition. It was treated operatively by open reduction and internal fixation using screws. At the time of the latest follow up, the result was satisfactory.     

Rupture du muscle grand pectoral : à propos d’un cas

Pectoralis-major tendon rupture is a rare injury. It occurs in young, healthy athletes during violent, eccentric contraction of the muscle with the arm held in an abducted, extended position. Often undiagnosed at the beginning, the diagnosis is confirmed by magnetic resonance imaging. Early operative treatment is associated with better outcome than delayed treatment; however, both of them are better than conservative treatment.     

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.     

Coalitions du tarse ou « fausses entorses » de l’enfant et de l’adolescent. À propos d’un cas

Tarsal coalitions, also called synostoses, are a cause of pain and gait disturbance in children and adolescents. They are often diagnosed as tarsal sprains, leading to an inappropriate functional prognosis. This is the case of an 8-year-old child with talo-calcaneum synostosis, presenting pain, hind-foot stiffness and marked disability in daily life activities and sports.     

Arrachements des épines iliaques antérosupérieures et antéro-inférieures chez l’enfant et l’adolescent sportifs. À propos de dix cas

The avulsions of anterior-iliac spines in child and adolescent athletes are rare injuries. All children have been treated as orthopaedic with strict rest, nonsteroidal anti-inflammatory substances and dispensation of sport for three months. No subsequent sequelae has been reported, all patients who got back to a sporting activity identical to that practiced before accident. It seems that the orthopaedic treatment among adolescents and children victims of avulsions of anterior-iliac apophysis, superior or inferior, is sufficient and does not involve any subsequent sequelae.