Anterior superior iliac spine avulsion in a young soccer player

Avulsion fractures of the anterior superior iliac spine are rare. They usually occur in teenagers during sport activities. Cases concerning adults are very uncommon. We report here the case of a 23-year-old man who was admitted for recent pain of the left hip that worsened while kicking a ball in a soccer match eight days earlier. The examination found pain when moving the left hip in extension. Radiographs showed an avulsion fracture of the left anterior superior iliac spine, which was confirmed by computer tomography. The treatment was conservative consisting in rest and non-weight bearing with releasing of pain a few weeks later.     

Bilateral Spontaneous Dissecting Common Iliac Artery Aneurysms: A Rare Presentation

Background

Spontaneous iliac artery dissection is a rare clinical entity, reported previously in pregnant patients in association with collagen vascular disease, and in cases of high-energy trauma or intensive activity in athletes.

Objective

To alert clinicians to the incidence of spontaneous iliac artery dissection in the absence of any risk factors.

Case Report

We report a case of a 45-year-old man brought into the Emergency Department with severe lower abdominal pain. Computed tomography angiography revealed bilateral common iliac artery dissecting aneurysms with a dissection flap extending into the left internal iliac artery.

Conclusions

This case demonstrates that despite being a rare condition, in cases of acute lower abdominal, inguinal or lower back pain, even in the absence of risk factors and limb ischemia, emergency physicians should maintain a broad differential that includes intra-abdominal/pelvic vascular pathology such as iliac artery dissection.     

Avulsion fracture of the anterior superior iliac spine in a collegiate distance runner.

Overuse injuries are a common occurrence with distance runners, yet injuries to the iliac crest are rare in this population. When an iliac crest injury occurs, it is usually associated with the weak unossified growth plate. The condition may present itself as apophysitis and may progress to an avulsion fracture. This is a report of a rare case in which a collegiate distance runner had an avulsion fracture of his anterior superior iliac spine (ASIS). Treatment consisted of rest followed by nonweight-bearing graded exercise performed in the pool and on a Schwinn Airdyne. The graded exercise not only strengthened and stabilized the muscles acting on the hip and thigh, but it also enabled the athlete to maintain his cardiorespiratory endurance. He returned to competition three weeks after the injury.     

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.     

La prise en charge rééducative globale de patients présentant un syndrome fémoro-patellaire : la lutte contre l’effondrement du membre inférieur par le renforcement du moyen fessier

The patellofemoral pain syndrome (PPS) is characterized by anterior knee pain and poor patellar kinetics. In this review, we focus on primary PPS. Several local factors are known to provoke knee pain (subchondral bony disorders, retraction of the lateral retinaculum, inflammation of the infrapatellar adipose pad). Furthermore, proximal factors involving the hip and pelvis as well as distal factors involving the ankle and foot explain the impact on lower limb mechanics, for instance on single-stance squat. In the 1980s, the gold standard management strategy for PPS was to strengthen the vastus medialis in order to counter lateral subluxation of the patella during knee flexion. More recently, with improved techniques for neuromuscular biomechanical investigations, several publications propose reinforcing the hip abductor muscles for PPS. This offers a more global approach by correcting the posture of the entire lower limb to provide relief from this difficult-to-treat complex syndrome. Strengthening the hip abductors (gluteus medius) appears to be the best way to eliminate the single-stance lower limb postural failure leading to several musculoskeletal disorders. This new approach to rehabilitation is a validated evidence-based therapeutic strategy.     

Thrombosis of external iliac and common femoral arteries secondary to blunt trauma due to handlebar injury

BackgroundVascular injuries are uncommon following a bicycle handlebar injury in children. However, they are associated with an extremely high morbidity including limb loss and asymmetric limb growth.Case presentation11 year old previously healthy female who presented to a pediatric emergency department immediately after sustaining blunt trauma to her abdomen by a bicycle handlebar. She complained of pain in her right lower extremity without paresthesia and was noted to have a painful superficial laceration to the right lower abdomen with tenderness on palpation. The extremity was noted to be mottled, cool to touch, with decreased sensations and delayed capillary refill but intact motor function. The peripheral pulses in the extremity were noted to be absent on exam, which was confirmed by a bedside Doppler. A Computed Tomography Angiography (CTA) of the abdomen and pelvis revealed an occluding thrombus in the external iliac and right common femoral arteries which required surgical repair. She subsequently developed occlusion secondary to traumatic dissection and compartment syndrome in the same extremity requiring repeat surgical intervention.ConclusionIn managing patients with blunt force trauma to the abdomen from handlebars, clinicians should have a high index of suspicion for vascular injuries even with low-risk mechanism of injury and superficial injuries noted on exam. Their assessment should include immediate examination of bilateral peripheral pulses of the lower extremities to evaluate for clinical findings associated with acute lower limb ischemia as well as bedside Doppler exams and early consideration of CTA to assess for occult vascular injury.     

Sciatic neuropathy secondary to a uterine fibroid: a case report

Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.     

Avulsion de l’insertion fémorale du ligament croisé antérieur chez un adulte de 20 ans. À propos d’un cas

The cruciate ligament (ACL) injury is known in adults and his surgical treatment is often necessary. In addition, avulsion fracture of the ligament's tibial insertion especially interested. Indeed, only a few cases of avulsion or proximal femoral ACL have been reported and always concerned children. Through this article, the authors describe a rare case of femoral osteochondral avulsion fracture of ACL in a young adult of 20 years which followed a sports accident.     

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.     

Primary extraskeletal Ewing’s sarcoma of the lumbar nerve root: A case report

BACKGROUNDEwing’s sarcoma (ES) is a highly aggressive bone malignancy. Extraskeletal ES (EES) originating in the spinal canal is extremely rare. Herein, we report on a rare case of EES with a primary lumbar spinal nerve root including the complete diagnosis and treatment.CASE SUMMARYA young female patient presented with a complaint of right lower limb pain for 1 mo. Magnetic resonance imaging (MRI) revealed an 11 mm × 14 mm × 31 mm mass in the lumbar epidural region extending at the fifth lumbar spine (L5) level toward the right L5 neural foramen. Our initial diagnosis was an epidural schwannoma. The patient underwent total laminectomy, tumor resection and pedicle screw internal fixation and the L5 root tumor was found to have been completely removed intraoperatively. Histopathological examination of the lesion showed a typical ES with a large number of small, round cells. Immunohistochemistry analysis indicated positive CD99 and S100. After surgery, the patient received chemotherapy and radiotherapy with a 1 year of follow-up and no recurrent tumors or new lesions were found upon spine MRI and positron emission tomography/computed tomography reexamination.CONCLUSIONClinically, ES outside the bone should be considered when nerve root tumors are encountered inside and outside the spinal canal and the diagnosis should be determined by pathological biopsy. After surgical resection, chemotherapy and radiotherapy should be performed. After treatment, active follow-up and regular review should be completed.     

Comment prévenir l’altération rachidienne lombaire et les blessures chez le jeune sportif

Objectives

The discovery of lumbar damage early in the practice of high level sporting activity led us to propose a simple program for the protection of the lumbar spine, applicable to each training session, since the age of 10 years, to limit the deleterious effects of physical activity.

Patients and method

A previous study realized in 30 young patients with lumbar pain has evidenced the effectiveness of a simple functional restoration program. We used it to propose preventive lumbar injury exercises combined in a comprehensive program with exercises for the prevention of lower limbs injuries.

Discussion

No longitudinal study has been realised on the potentially deleterious effects of early high level sport activity and no program is currently offered in a systematic way to limit its possible harmful effects. The simplicity of the protocol that we propose, validated for the spine allows its integration into a prevention program during the training of youth, since the beginning of rachis growth phase.

Conclusion

The early disc degeneration is a reality in combat and contact sports. Careful clinical monitoring is necessary to detect and take care of these pathologies. But as a priority, it is necessary to integrate since the young age a program of protection of the spine and to adapt it to the growing constraints required in above age categories, depending on the level of practice and this until the age of 18 years. This program is effective in the school rugby of the Association Sportive Montferrandaise and in the training centre.     

Rupture traumatique du tendon du grand pectoral chez le rugbyman

Humeral avulsion of pectoralis major tendon is not so rare in rugby practice even if it is less frequent than for fifty years old bodybuilder. Clinical diagnosis is generally evident but can be confirmed by a RMI. In case of total avulsion, surgical reattachment has to be performed to recover plain function and expect a return to competition. Procedure consists in a humeral reattachment using suture anchors. Usually, specific rugby training begins after three months.     

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.     

Treatment of refractory pain after brachial plexus avulsion with dorsal root entry zone lesions. (Medical School Hannover, Hannover, Germany) Neurosurgery. 2001;48:1269–1275.

Forty‐seven patients with intractable pain after traumatic cervical root avulsions were treated with dorsal root entry zone coagulation between 1980 and 1998. The dorsal root entry zone coagulation procedure was performed 4 months to 12 years after the trauma, and patients were monitored for up to 18 years. Immediately after surgery, 75% of the patients experienced significant pain reduction; this value was reduced to 63% during long‐term follow‐up monitoring. Nine patients experienced major complications including subdural hematomas and motor weakness of the lower limb. Improved coagulation electrodes with thermistors that could produce smaller and more accurate lesion sizes, which were introduced in 1989, significantly reduced the number of complications. Conclude that long‐term follow‐up monitoring of patients who underwent the dorsal root entry zone coagulation procedure in the cervical cord indicated that long‐lasting satisfactory relief is possible for the majority of individuals with acceptable morbidity rates. Comment by Ron Pawl, M.D. This paper is important for several reasons. It provides a long‐term follow‐up on patients suffering intractable pain after cervical nerve root avulsion from the cord, and results of dorsal root entry zone lesioning using the thermocoagulation technique, where lesions are made at 1 mm intervals covering the length of the cord and one level above and one below the levels of the roots involved. Thirty‐nine of 47 patients had 63% reduction of pain in follow‐up of 2 to 18 years (14 year average). The authors also reported that 9 patients experienced major complications including subdural hematomas and lower extremity weakness, which they attribute to the electrodes used to make the lesions prior to 1989. Using an improved electrode since that time, they report fewer complications. Also, the authors note no correlation between the duration of the pain, the time between the trauma and the surgery, and the time of onset of the pain after trauma with the outcome of the surgery, indicating the procedure is effective, even when carried out years after the onset of the pain. This last concept puts a damper on the idea of centralized pain memory as the mechanism for the chronic pain.     

La fracture de fatigue du col fémoral chez le sportif d’endurance : l’importance d’un diagnostic précoce

Stress fractures of the femoral neck are rare traumatic events but they are far from being exceptional within the high level sportsmen community and even less rare within the military. The authors report the case of a 19 years old young man enlisted in the French Foreign Legion. He came up with a right femoral neck stress fracture as a result of intense physical exercices. Although painful prodromic signs had been evolving for 15 days, the right diagnosis wasn’t made until the fracture moved to Garden III. The surgical treatment consisted in a reduction with a triple screwing of the femoral neck. One year later, the fracture was set to anatomic position, the hip function was normal and the femoral head showed no signs of osteonecrosis. The patient was then lost for further follow-up. When there has been no slipping, these fractures develop favourably with an ad integrum hip restoration. On the other hand, a secondary slipping leads to a pathology that has to be taken care of in a quite different way, with an often catastrophic outcome at the functional level. Nearly constant prodromic signs come in usefully for an early diagnosis. Secondary slipping of the femoral neck stress fractures should happen less frequently by an appropriate awareness campaign aimed at all the health professionals including sports trainers.     

Paralysie complète du quadriceps secondaire à un hématome post-traumatique du muscle iliopsoas de diagnostic tardif : à propos d’un cas

Paralysis of the femoral nerve secondary to compression from a hematoma of the iliopsoas muscle in the lesser pelvis is a well-known complication of anticoagulants and certain surgical procedures, but is a rare post-traumatic event. A 16-year-old teenage boy presented with a painful, swollen knee with an active extension deficit of the leg following a fall. Seven weeks before he had also received a blunt trauma to the greater trochanter of the homolateral hip. The diagnosis of a patellar tendon tear was first suggested, but this was eliminated on MRI. A close clinical evaluation showed complete paralysis of the quadriceps with a sensory deficit of the anterior side of the thigh. MRI of the lesser pelvis showed a massive iliopsoas hematoma compressing the femoral nerve. Surgical evacuation was performed 9 weeks after the original trauma. At 6 months of follow-up, recovery of the muscle was complete and the electromyogram was normal.     

Sequential retroperitoneal venous hemorrhage and embolism of an angio-seal puncture closure device complicating iliac artery angioplasty.

PURPOSE: To present a case of iatrogenic puncture closure device embolization complicating surgery for retroperitoneal hemorrhage (RPH) secondary to angioplasty-induced common iliac vein trauma. METHODS AND RESULTS: A 78-year-old woman with rest pain underwent successful kissing balloon dilation of her aortoiliac bifurcation for a calcified ostial stenosis of the left common iliac artery. Hemostatic puncture closure devices (Angio-Seal) were used to secure both femoral punctures. A right-sided retroperitoneal hematoma developed, and during surgical exploration of the right groin, the Angio-Seal device was removed. The only bleeding site found was the external iliac artery puncture and it was repaired. She again became hypovolemic 18 hours later and was returned to surgery, where bilateral groin explorations and laparotomy by the vascular surgical team found a tear in the left common iliac vein. After repair, the patient was stable for 48 hours when the left leg became critically ischemic. Angiography detected a new high-grade stenosis in the left profunda femoris artery; embolectomy retrieved a footplate from the left puncture closure device. The patient died 11 days later from multiorgan failure. CONCLUSIONS: RPH should be considered early as an occult cause of hypovolemic shock developing soon after even technically straightforward iliac angioplasty. Interventionists should be aware that using the Angio-Seal device risks acute limb ischemia if footplate embolization occurs.     

Spécificités de la pratique du rugby chez l'enfant

The knowledge of the specificity of the child compared to the adult and his reactions regarding the exercise will make it possible to answer parents questions as well as possible and to accompany the child and the teenager in their sporting practice. Five essential concepts govern the practice of Rugby in the child: 1) the child is not an adult in miniature. It is an organization in constant evolution towards its physical and psychic statute of adult. He has a free will depending on the others; 2) Rugby must remain for him a ludic space, where the motivation must be the first condition; 3) the child is a mosaic of growth cartilages. Traumatic pathology is preferentially a pathology of this structure in the acute traumatisms (epiphysium separation rather than distorsion, muscular apophyse avulsion rather than tear) and under the effect of chronic microtraumatisms (osteochondrosis rather than tendinitis); 4) overtraining will result in a disturbance of one of the factors of the general balance of the organization which it acts of a pain, of against performance, an abnormal tiredness, of a demotivation, a relational disorder (mood, affectivity), of lower school output of which it will be necessary to establish a relationship to the sporting practice; 5) the execution of a sporting gesture must always be modulated as of the appearance of a pain, true alarm.     

Traumatic appendicitis in minor blunt abdominal injury

Trauma has been reported as a cause of appendicitis on several cases in the literature. The present study reports the relationship between blunt abdominal trauma (BAT) of injury severity score less than 4 and appendicitis. A 17‐year‐old girl developed appendicitis after a minor BAT. An ecchymosis at the right lower quadrant misled the diagnosis, which was made 1 day later. Laparotomy revealed an inflamed appendix, a few enlarged mesenteric lymph nodes, contusion, as well as punctuated bleeding sites of the caecum. Moreover, based on a brief literature review, the different pathophysiological mechanisms and the difficulties of diagnosis of this entity are discussed. It is suggested that appendicitis should be considered as a possibility in the setting of right lower quadrant pain following minor BAT, when there is clinical suspicion of an inflammatory process within the right iliac fossa.