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.     

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.     

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.     

Pente tibiale et rupture du ligament croisé antérieur : étude anatomoradiologique

Studies of knee-joint anatomy and biomechanics have demonstrated a main intrinsic factor having a negative impact on the anterior cruciate ligament (ACL): a weak tibial slope. The purpose of this work was to study tibial slope measured on plain X-rays in knees with and without ACL tears.     

Laxité chronique antérieure du genou chez le sportif. À propos de 118 cas

The chronic anterior laxity of the knee is an evolutive disease owing to a rupture of the anterior crossed ligament which engages the functional prognosis of the lower member and compromise sportive activity. Many techniques of ligamentous plasty were described. Our study is about 118 sportsmen suffering from chronic anterior laxity treated by the modified Kenneth-Jones procedure between 1998 and 2002. After a main following-up of 25 months, we tried to value our results and determine the real place of ligamentous plasty using patellar tendon in the treatment of sportsmen chronic anterior laxity.     

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.     

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.     

La luxation antérieure du coude associée à une fracture de l’olécrâne : une forme rare de luxation du coude chez l’enfant

Elbow dislocation is exceptional in children due to the minimal resistance of the joint capsule and ligaments compared with the bony structure. Posterior dislocations do occur, but anterior dislocation is even more exceptional. The diagnosis is often missed. We report a case of anterior elbow dislocation in a child.     

L’apport du muscle pectoralis minor dans le traitement de l’instabilité antérieure de l’épaule

The surgical stabilization of the shoulder knew many technical improvements energy. We propose a preliminary study about an engineering change by the addition of a fourth muscular bolt for the treatment of former instabilities of the shoulder. Our study is prospective gathering 16 patients having a stabilization of the shoulder by a quadruple locking using an osseous thrust by the coaracoid process, a tendineux bolt by a hammock applied thanks to the coaraco-biceps tendon to the lower bank of the sub-scapularis, a capsular bolt by joining the acromio-coracoid ligament to the glenohumeral capsule and a fourth bolt by the joining of the pectoral small tendon to the coraco-biceps. Our results evaluated by the score of Dupaly after 18 months show that the average retreat are satisfactory with an early resumption of the activity (2 months on average). The techniques of former stabilization of the shoulder are currently allowing that triple locking is indicated among all patients whose score ISIS exceeds five points. The addition of small pectoral as fourth bolt seems to us as well interesting because of the good preliminary results.     

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.     

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.     

Influence des facteurs intrinsèques anatomiques dans la rupture du ligament croisé antérieur : étude anatomoradiologique comparative

Studies of knee-joint anatomy and biomechanics have demonstrated to main intrinsic factor shaving a negative impact on the anterior-cruciate ligament (ACL): a narrow intercondylar notch and a weak tibial slope. The purpose of this work was to study tibial slope and width of the intercondylar notch measured on plain X-rays and magnetic resonance imaging (MRI) in knees with and without ACL tears.     

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 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.     

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.     

Agénésie du ligament croisé antérieur et du ligament croisé postérieur du genou

This case report is an agenesia of the anterior and posterior cruciate ligament of the knee on a young man 35 year old. This malformation is rare and exceptional. The clinic is principally a knee laxity. On the plains radiographics, the diagnostic can be made because there is a hypoplasia or an agenesia of the tibial eminence and a malformation of the femoral intercondylar notch. MRI confirms the diagnostic.     

Revue de littérature : la rupture du ligament croisé antérieur : particularités féminines

We know that female athletes practicing pivoting sports have a higher risk of anterior cruciate ligament (ACL) injury compared to male. Many series confirm that the risk is four to seven times higher among female athletes at the same sporting level. Furthermore, most ACL injuries in female athletes occur during a noncontact episode, typically during deceleration, lateral pivoting or landing. A literature review confirms the higher incidence of ACL injuries among women in the pivot sports with or without contact. This sex difference can be explained by external and internal risk factors. The external risk factors are competition in games versus training, footwear and playing surfaces, protective equipment and physical preparation. The internal risk factors are anatomical risk factors: anatomy of the notch, posterior tibial slope, hyperlaxity, biomechanical factors: kinematics and kinetics of the knee, neuromuscular risk factors and hormonal risk factors. Indeed, the hormonal factors (estrogen, relaxin, progesterone and testosterone) seem to be responsible, especially during the ovulatory phase of the menstrual cycle. This study confirms that female athletes have a higher risk of ACL injuries compared to male athletes. A better knowledge of the external and internal risk factors, such as the injury mechanism and the hormonal factors may help in the future prevent these injuries.     

L'ostéotomie tibiale chez le rugbyman professionnel. À propos de six cas

We report our experience of tibial osteotomy on 6 professional Rugby players. At revision, one was lost because he lived too far from our center, but still plays rugby. Five experienced a functional IKDC score (International Knee Documentation Committee) between 86/100 and 99/100 (versus 55/100 to 71/100 pre operative) and all returned to their sport at the same level. Modification of HKA angle (Hip-Knee-Ankle) didn't modify the impulsions during playing. Chondromalacia seems to go on despite the procedure. In all cases, pre-op washing arthroscopies (± viscosupplementation) failed. In conclusion, tibial osteotomy appears to be a quite simple procedure in the management of symptomatic chondromalacia for high level sportmen. Because of a quite short term follow up, it's impossible to preview long-term results of these osteotomies on arthro evolution.     

Épidémiologie des ruptures du ligament croisé antérieur du genou chez la joueuse de football de haut niveau : à propos de 66 cas

Our study focussed on the rupture of the anterior cruciate ligament in high level female soccer players in first and second national divisions. To this effect, we used a questionnaire to analyse 66 cases of anterior cruciate ligament injury according to the following criteria: age at the time of injury, the side injured, laterality, circumstances of the accident, the type of treatment (surgical or functional), the type of surgery, recovery time, the level of recovery, initial care in a rehabilitation centre. Rupture is generally due to a non-contact injury (65%), which is comparable with a male population of the same level. The risk of repeated rupture, in a player continuing her career, is significant (> 10%). The type of surgery does not affect return to sport. However, for high-level female soccer players, rehabilitation in a specialised centre improves the chances of returning at the same level (p < 0.025).