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.     

Évaluations prédictives de l’entorse de cheville. À propos de 58 cas

When an injury comes out, it is seen like a fatality for a sportsman and the medical staff. The ankle sprain is from far the most common pathology. Preventions programs proved their efficiency in many fields. However, it is very hard to put them into practice because there is few or no tools to these persons. The goal of this work is to provide assessments reliable, reproducible and non-dependent operator that will identify potential topics victim of a sprain ankle in the medium term. We tested 58 youngs healthy athletes whose sport practice was up to 2 hours a week. We have made assessments on a motor coordination machine, on a posturography platform and we analysed the muscular benefits of each lower limbs thanks to a accelerometer. These analyses have been done in November 2007, January 2008 and March 2008. We sorted out five articulars instability. Topics victims of the ankle sprain during the study got a 13% coordination deficiency. The difference is statisticly significant. All the tests which have been done on the postuography plateform were not accepted because the evaluation results were not comparables with the 1985 norms of the French Association of Posturology. We were able to see a curve problem with wounded patients during the ground absorbtion phase and had a stabilisation time shorter than the one for the healthy subjects. This significative difference was up to 110 ms. Pope et al. find out on patients hit by a talocrural sprain, a significative diminution of the dorsiflexion during the previous traumatism report. Willems et al. find these facts and describe others intrinsic factors of predisposition which match our results. Our work proved that it is possible to warn, in a mid term, the sprain of the ankle. These warnings reports must be done in the beginning of the sporting season and will allow to determine the athletes weakness thanks to reliable and reproducible evaluations.     

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.     

Traitement de la laxité latérale de cheville par ligamentoplastie à l’hémitendon du court fibulaire avec remise en tension capsuloligamentaire

The authors developed an original method, using tenodesis and anatomical repair, for the treatment of lateral chronic instability of the ankle in young military people. In this medium-term retrospective study, 32 patients were rewieved for functional and radiological evaluation. With a mean follow-up period of 20 months (range from six to 64 months), 90.6% (n = 29) of the patients were “satisfied” or “very satisfied”, 78.1% (n = 25) were painfree, but 15,6% (n = 5) complained about stiffness. Ninety-seven percent of them (n = 31) returned to athletic activity and no instability occured. The mean score for the Olerud and Molander Ankle Score was 91.5 (range from 70 to 100). On postoperative stress radiographs the mean side-to-side talar tilt difference was 0.6 ± 2.9°. The mean loosening of eversion isometric strength on the ankle operated was 5.4%. The present study demonstrates that this mixed procedure give excellent results in terms of stability, despite of a well-tolerated stiffness.     

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.     

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.     

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.     

Fracture de Mac Farland chez l’enfant. À propos de 15 cas

McFarland fractures are articular fractures of the ankle of the child, whose fracture line through the medial part of the growth cartilage of the lower end of the tibia. The treatment of these fractures remains problematic because of the risk of default or epiphysiodesis reduction intra-articular, with risks of malalignment and osteoarthritis. We report a series of 16 fractures including a bilateral McFarland collected over a period of six years between January 2004 and December 2009 in the service of trauma-orthopedic pediatric (CHU Hassan II of Fez). The average age of our patients was 12 years (five to 15 years) with female and eleven patients were operated: a screw in eight cases and a plug in three cases, the outcome was favorable with a mean of 23 months except for one patient who presented an epiphysiodesis.     

La rupture du tendon calcanéen : à propos de 53 cas

The Achilles tendon is the most resistant of the tendons of the human body; its rupture is increasingly frequent in the world and our country because of the considerable development of the sporting activities. This retrospective study relates to 53 observations listed in the service of traumatology and orthopedics of the Hospital Avicenne of Rabat over a period of 5 years between 2005 and 2009. Each patient underwent monitoring protocolisé. Criteria for Comis were used for clinical evaluation. All patients received open surgery. The middle age was of 37 years. The clinical examination was sufficient to pose the diagnosis. All the patients profited from an open surgery. Three patients presented pain after surgery. Infection local skin was noted in two patients. One patient presented a rerupture and 88.6% of the patients have very good performances. The rupture of the Achilles tendon is much more frequent in men; this is explained by the frequency of sports activity in men. Three patients had a history of tendinitis. Clinical examination was easy enough for diagnosis. Open surgical treatment remains the method most widely and most used. In the classic controversy between the effectiveness of surgical and orthopedic treatment in the rupture of the Achilles tendon, the emergence and development of percutaneous techniques still currently did not make it possible to conclude to the superiority of treatment over another.     

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.     

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).     

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.     

Évaluation d’un protocole de kinésithérapie ambulatoire pour la prise en charge des coxarthroses et conflits antérieurs fémoro-acétabulaires des sportifs

Introduction

Hip osteoarthritis and femoroacetabular impingement frequently affect sportsmen and are origins of permanent incapacity. The therapic behaviour before surgery step is not yet established. Physiotherapy is often suggested but it is still difficult to prescribe it correctly. The main goal of our study is to show superiority, both in terms of decrease of pain and increase of sportive activity, of the process “PROTOCOX” including both physiotherapy and manual therapy in comparison with a physiotherapy process “CONTROLE”.

Method

Twenty-six sportive patients of the “Institut régional de médecine du sport de Haute Normandie (IRMSHN)” have been included in the study in an 18-month period. Our secondary aims are to show improvement of life quality and range of motion. Several data including HOOS and Lequesne index have been harvested before and after the six sessions and after 3 months.

Results

For patients (n = 11) of the “PROTOCOX” group (P = 0.034), a significant improvement of the HOOS index, mainly on pain (P = 0.04) and allowing an increase of sportive activity (P = 0.007). After 3 months, there was still a transitory improvement allowing an increase of sportive activity for 75% of the patients (n = 8) of the “PROTOCOX” group in comparison of 18.2% for the “CONTROLE” patients.

Conclusion

The “PROTOCOX” process is simple and practicable in liberal sector, and gives benefits in terms of decrease of pain and sportive activity increase with a reduce number of sessions and its transitory efficiency stays at mid term.     

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.     

Les instabilités antérieures de l’épaule. Á propos de 50 cas

We performed 54 consecutive Latarjet procedures for the treatment of recurrent anterior instability of the shoulder between 1996 and 2005. We retrospectively reviewed the clinical and radiographic results of the procedure. The procedure was performed for the treatment of recurrent anterior dislocation in 51 shoulders, painful recurrent anterior subluxation in two cases and painful shoulder in one case. All patients had a radiographic evaluation before the operation and at the latest follow-up examination. At the time of the latest follow-up, none of the patients had recurrent dislocation. According to the system of Rowe, 51 (94 %) of the 54 shoulders had an excellent or good result. Fifty-one shoulders had no glenohumeral osteoarthrosis.     

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.     

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.