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.     

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.     

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.     

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.     

Fracture bilatérale simultanée de rotule. À propos d’un cas

Bilateral simultaneous fractures of the patella occured with interruption of the apparatus bungee cord, in a young man is a exceptional occurrence. A mechanism in two times, without subjacent etiology, contributes to accentuate the originality of this observation. The authors propose to describe the assumptions of the organic mechanism and the physical therapeutic. The goal is the functional recovery most optimal and the restitution of a military efficiency.     

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.     

Fracture ouverte de la clavicule et traitement par fixateur externe. À propos d’un cas et revue de la littérature

Introduction

Clavicular fractures are treated by orthopedic means or by surgery with internal fixation. Most open fractures are also treated surgically but the use of external fixator remains exceptional.

Clinical case

It is about a 23-year-old patient presenting secondary punctiform cutaneous opening within the framework of clavicule fracture. The fracture had remained exposed for more than 24 hours. After trimming of the wound and reduction, the stabilization of its fracture was carried out by an external fixator Percy Fx^®. The patient directly began rehabilitation for his upper limb. No infection was noted. On the third month, the callous was solid enough to allow hardware removal simple sedation.

Discussion

The cutaneous opening of the clavicule fractures is rare and represents less than one case over 1000. The open fractures in polytrauma patients are accompanied by other direct vascular, nervous even pulmonary complications. In the case of open fracture, surgery is indicated either by intramedullary nailing or with plate and screw fixation. However, the use of an external fixator is recommended by certain authors. The stabilization of this fracture was carried out by an external fixator whose flexibility, light character and radiotransparency, facilitated the follow up.

Conclusion

Although the installation of an external fixator remains exceptional for the treatment of an open clavicule fracture, this method could be under certain conditions an alternative technique to osteosynthesis.     

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.     

Luxation traumatique de l’appareil extenseur au dos de l’articulation métacarpophalangienne. À propos d’un cas et revue de la littérature

The authors report the case of a dislocation of the extensor tendon over the metacarpophalangeal joint of the long finger, resulting from posttraumatic rupture of the radial sagittal band. A surgical procedure was performed to improve functional rehabilitation. The outcome at six months was excellent and the patient returned to sports, without recurrence of extensor tendon instability.     

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.     

L’ostéome ostéoïde du col fémoral du sportif : intérêt de la résection percutanée scanno-guidée (À propos de 11 cas avec revue de la littérature)

Introduction

Treatment of the osteoid osteoma was based a long time on the surgical resection, but with a considerable frequency of complications. The percutaneous resection tomography-guided belongs to therapeutic progress of these last years, it became the method of choice for the treatment of osteoid osteoma in our institution. The purpose of our study is to evaluate effectiveness of this technic by analyzing the clinical evolution, the duration of convalescence and resumption of sports activities.

Patients and methods

It is a retrospective study concerning 11 observations of osteoid osteoma of the femoral neck, treated and followed to the service of Traumatology-Orthopedy II of the military hospital of the CHU Rabat between January 2004 and October 2009. Our series was composed of three professional athletes, two footballers exercising in national shampionship and six soldiers subjected to a constant and regular drive.

Results

This intervention was done in the day's hospital, all the patients left the hospital the same day with resumption of the total support in the 24 hours following operation. Nine patients (80%) observed a total disappearance of the pain a few hours after the intervention. With a minimal retreat one year, no case of complication was raised. And finally on the subjective level all the patients were satisfied and took again their sports activities on the same former level.

Discussion

The treatment for osteoid osteoma must be simple, precise, effective and the least expensive possible. In the light of our results and those brought back in the literature, the percutaneous resection tomography-guided is proven effective, sure, not very invasive and is associated with a reduction in the health expenditure. It can be recommended like the treatment of choice of osteoid osteoma as well for the femoral neck as for the other localisations. More aggressive and more expensive treatments are difficult to justify, in particular in sportsmen, thus allowing them a fast convalescence and an early recovery their sports activities.     

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.     

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.     

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.     

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.