Ostéome ostéoïde du talus chez un footballeur professionnel

We report a case of osteoid osteoma of the talus in a professional soccer player. The surgical excision leads to an excellent result, because of a location at the neck of the talus of the tumor. This lesion must be known by the sports physicians to avoid misdiagnosis.     

Ostéome ostéoïde du grand trochanter révélé par une sciatalgie chez un sportif

Osteoid osteoma is a benign osseous tumour in the young adult most commonly found in the appendicular skeleton. This tumor makes preferentially on long bone diaphyse. The particular locations of the osteoid osteoma are at the origin of diagnostic wanderings. In same cases, nothing directs clinically to an osteoid osteoma. We report an unusual case of osteoid osteoma of the greater trochanter in a 21-year-old sportsman revealed by sciatica. We discuss the role of different imaging techniques in diagnosis and treatment of this benign tumor.     

Ressaut distal du biceps fémoral : à propos de 2 cas et revue de la littérature

Snapping of the biceps femoris over the fibular head is an uncommon condition. Reported causes include an anomalous insertionof the tendon, trauma at the insertion site of the tendon, and an abnormality of the fibular head. This article reports two cases of a painful snapping biceps femoris tendon. Medical management resulted in a complete resolution of symtoms.     

Rupture post-traumatique négligée du retinaculum extensorum à la cheville. À propos d’un cas et revue de la littérature

Post-traumatic ruptures of the retinaculum extensorum (RE) to the ankle is rare and behind a tendinous luxation, of a rope effect, tiredness and weakening or loss of strength. We report the observation of a patient aged 35 practicing full contact for 20 years, victim of a sports accident two years before upon a foot kick in the kicking bag during a training session bringing about a rupture of the RE at the ankle. Imagery (echography and MRI) made sure the clinical exam and to call for the diagnosis of the rupture of the lower band of the retinaculum with subluxation of the tendons of the tibialis anterior and of the extensor hellucis longus. The take in charge consisted of a local plasty of the RE. On the relapse (6 months), the patient is satisfied with the outcome and taking back to his initial sports activity. Through our observation and a review of the literature, we attempt to review the anatomy of the RE to the ankle and to analyze the causes and the consequences of its rupture as well as the usefulness of the imagery in analyzing its anatomic structure. The rupture of the RE is a rare affection mainly affecting sports persons. They can be unseen and may compromise the sports career of athletes. A meticulous clinical exam and targeting imagery as well as an adequate take in charge allow avoiding this unwanted evolution.     

Ostéochondrites disséquantes rares du genou chez l’enfant. À propos d’un cas tibial et d’ un cas rotulien et revue de la littérature

Osteochondritis dissecans is a rare condition and often involves the medial femoral condyle. We are here reporting two uncommon localizations in children involving the lateral portion of the tibial plateau in one and the patella in the other. They were two fourteen-year-old boys with respectively 4 and 3 months history of a right knee pain and locking. No previous trauma had been noted. X-ray studies and MR images provided definitive diagnosis. However, in the tibial localization, osteochondritis was associated to a damaged lateral discoid menisci and in the patellar localization, the osteochondral fragment was detached in the joint. Regularization of the lateral menisci and removal of a loose body were respectively performed under arthroscopy in the two knees. Literature is reviewed with an emphasis particularly on pathogenesis of these rare localizations.     

Fracture de fatigue du sésamoïde tibial. Présentation d’un cas et revue de la littérature

Sesamoids are accessory peripheral bones around the metatarsophalangial joint of the first toe. They are almost constant although some rare congenital absences have been described. They work like a pulley and increase the traction power of muscles during the last stage of the step. Clinical diagnosis of stress fracture is often difficult to establish because different pathologies are usually intertwined. Sensitive elective palpation of the sesamoids, local tumefaction, painful passive metatarsophalangial extension and walk with supination of the forefoot lead to one of the following diagnoses: static or microtraumatic pathologies, osteonecrosis, microcrystalline arthropathy, rheumatoid arthritis, infections, developmental abnormalities, perisesamoidal soft tissue injuries, or even less common etiologies. Radiologic examinations (Guntz view) allow for a precise evaluation of the sesamoid bones. According to the suspected diagnosis, computed tomodensitometry, magnetic resonance or scintigraphy can be performed. The initial treatment is a conservative one; if it is not responsive, surgical treatment can be suggested but usually leads to muscular instability.     

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.     

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.     

Rupture post-traumatique du tendon patellaire (à propos d’un cas et une revue de la littérature)

Subcutaneous ruptures of patellar tendon are exceptional but very disabling, the authors bring report a case of rupture at a sportsman further to a foul in a volleyball match, the treatment was surgical, made by joinings and reposition of the apparatus bungee cord by a cerclage wire during six weeks. The functional results were very satisfactory with a correct active extension after the rehabilitation. We try through this case and a review of the literature to underline the rarity of this entity, its predisposing factors, and the difficulty its therapeutic coverage as well as the interest of the premature rehabilitation post-operating, which conditions the functional recovery of the knee.     

Ostéomyélite du pubis chez un athlète : à propos d’un cas et revue de la littérature

Osteomyelitis of the pubis has rarely been described. We report a case of pubic osteomyelitis with Staphylococcus aureus at sub periosteal abscess occurred in a custodial football aged 17. It was presented in a table feverish pain in the groin with a left and a functional sensitivity of the symphysis pubis. The diagnosis was based on blood cultures, biology, ultrasound and MRI performed in emergency. The surgical treatment was strongly associated with antibiotic therapy adapted to the germ. The pathogenesis of this entity is probably the location of bacteraemia secondary to a bone redesigned by micro trauma. The treatment is based on prolonged antibiotic therapy. Surgical drainage is required for infections to rebel or medical treatment in case of abscess.     

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.     

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.     

Les accidents musculo-squelettiques avec les consoles vidéos de nouvelle génération. À propos d’un cas et revue de la littérature

The rise of next generation consoles game, with their share of sport simulations, has caused appearance of new sport injuries. We present a case of a traumatic rupture of the calcaneal tendon, after a game of virtual sport. It concerned a non-athletic 40-year-old woman. The surgery was performed with a very good long-term result. Literature review demonstrated the extent of these pathologies, with a prevalence of musculoskeletal troubles.     

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.     

Ténorraphie percutanée pour rupture fraîche sous-cutanée du tendon calcanéen. À propos de 28 cas

The under cutaneous rupture of the tendon of Achilles is increasingly frequent because of the considerable development of the sports activities and the increase in their intensities. In the beginning, the treatment of the tendon of Achilles rupture was orthopedical, then it was supplanted by the advent of the surgery. The comparisons between the advantages and the disadvantages of the two methods made it possible to gradually develop a technique of percutaneous tenorraphy, which takes its place according to the risks or insufficiencies of the other therapeutic methods. Our study is related to 28 observations of recent under cutaneous ruptures, in full tendinous body, treated and followed in the service of traumatology-orthopedy II of Mohammed V military hospital of instruction between January 2002 and April 2009. Our series was composed of nine professional sportsmen and 19 soldiers subjected to a constant and regular drive. All our patients profited during this period from a percutaneous tenorraphy of the tendon of Achilles by using Ténolig^®. We obtained satisfactory functional results with resumption of the former sporting level for 25 patients. Concerning complications there was minor infections in four cases, namely the cutaneous excoriations under the discs, which responded to local care, no case of iterative rupture was brought back so far, neither thromboembolic accident nor major infections or nerve sural attacks.     

La fracture simultanée de Bennett et du trapèze chez un pilote de karting (à propos d’un cas et revue de la littérature)

Simultaneous trapezium and Bennett's fractures is rare. The authors report an observation of a professional kart pilot analyzed in the light of the literature. This lesion is likely to compromise the function of thumb if the treatment is not adapted. Osteosynthesis by screw is the only guarantor of an anatomical and stable reduction of metacarpal-trapezium joint. The results of the cases published are encouraging but are not conclusive compared to the occurrence of the arthritis in the long-term follow-up.     

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).     

Ostéotomies tibiales de valgisation associées à la ligamentoplastie du ligament croisé antérieur. À propos de 15 cas

The management of patients aged 30 to 50 years and with an anterior knee laxity in ACL tear associated with medial osteoarthritis femorotibial, is very difficult. Recent publications have shown that the combination of an valgus osteotomy and ligamentoplasty of the ACL is possible to halt the progression of osteoarthritis while correcting the laxity of the knee. We report our experience of 15 patients who received a valgus osteotomy associated with the ACL ligamentoplasty.     

Intérêt des infiltrations du « mur méniscal » par les corticoïdes dans les douleurs méniscales du genou. À propos de 214 cas

Femorotibial pain is a common manifestation of meniscal injury or microtrauma. In this situation, meniscectomy does not appear to accelerate joint degeneration. Meniscal wall steroid injections have been proposed for consenting patients suffering from degenerative or post-traumatic meniscal pain. The technique consists in injecting corticosteroids into a juxtameniscal zone after identification of the painful area by palpation of the joint space and radiographically. We conducted two non comparative studies: a first retrospective analysis of 178 patients aged 44 years on average and a second prospective series of 36 patients aged 39 years on average who were treated with one to three injections for meniscal pain. The main outcome assessment combined pain relief and return to prior activities at 60/90 days. Results were favorable in the retrospective series: 106 responders versus 46 non-responders (26 lost to follow-up) and also for the prospective series: 28 responders versus six non-responders (two lost to follow-up). Neither series yielded a clinical or radiographic finding predictive of outcome. The pattern of a “good” responder to treatment could not be identified. It was noted, however, that meniscal pain associated with a blocked knee appeared to be a poor indication for corticosteroid injections and that injections of hyaluronic acid should be associated in cases with cartilage damage. Meniscal wall injections thus appear to be a new perspective for the medical treatment of meniscal pain. Comparative studies versus arthroscopy will be needed to determine the role of this method in our therapeutic armamentarium.     

Fracture–avulsion isolée du tubercule mineur de l’humérus: À propos d’un cas et revue de la littérature

Isolated avulsion fracture of lesser tuberosity of humeral head is not infrequent. Usually diagnosis is delay or unrecognized and symptomatology is poor. Analysis of X-ray is often difficult because the avulsed bony insertion overlay on humeral head. The mechanism of injury is an excessive contracture of subscapularis muscle during a forced external rotation. Long biceps's instability is the main associated injury. The treatement is a sling immobilization with internal rotation of humeral head for no displaced fracture. Surgical treatement must be recommended for other cases. Deltopectoral approach with screw and anchor fixation is classical but one case of arthroscopic treatement has been described. The best treatement of long biceps's associated instability is section.