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.     

Rupture bilatérale du tendon patellaire chez un footballeur: À propos d’un cas

The authors report a case of spontaneous bilateral rupture of the patellar tendons in a footballer in match. He is known asthmatic under corticothérapie with the long course. He profits from a surgical repair made from transosseous joinings and reposition of the apparatus bungee cord by a cerclage wire. The peroperational adjustment height of the patella and the ousting of drilling of too posterior tunnels on the level of the patella are two guaranteeing technical requirements of better results.     

Traitement des ruptures négligées du tendon rotulien (à propos de deux cas)

The authors report two cases of neglected patellar ligament rupture treated surgically. The repair was made by suture of the tendon rotulien strengthened by a fragment of the vast medial associated with a hooping to the son of steel for the first case; and a reconstruction with transplant free bone-tendon-bone taken in depend on the knee controlateral, supported by a centring to the son of steel in 90°de flexion for the second case. No postoperative immobilization is made allowing beginning at once the re-education. The functional result was excellent on the active extension but with a sequellaire steepness concerning the flexion for the first patient. The surgical technique must be individually adapted; the centring of protection must be systematic but realized carefully to avoid the frequent abnormalities of location of the kneecap and the fémoro-patellaires conflicts and authorizing a fast reeducation. Through a review of the literature, we recall difficulties of care of this injury even on the diagnosis and therapeutic levels.     

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.     

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.     

Suivi des patients après injection de toxine botulique intradétrusorienne: Recommandations de bonne pratique clinique chez le patient neurologique

Injections of botulinum toxin into the detrusor is a major evolution for treatment of neurogenic bladder. They are now considered as a treatment of choice, safe and efficient, in refractory neurogenic overactivity in catheterized patient. To date, there are no consensual practical guidelines for the follow-up of patients having been treated by intradetrusor botulinum toxin, whatever the indication of the treatment, functional, that is, for improving continence and overactive bladder syndrome or organic, that is, for treatment of high-detrusor pressure and their deleterious impact of urinary tract. This lack of guidelines leads to heterogeneity of treatment management and limit the definition of optimal modalities of intradetrusor botulinum toxin treatment in neurogenic patients. The aim of your work, prepared jointly with the International Francophone Neuro-Urological expert study group (GENULF), aimed at putting forward well-informed specific recommendations for the follow-up of patients having been treated by intradetrusor botulinum toxin for functional or organic indication of neurogenic detrusor overactivity.